Provider Demographics
NPI:1811308778
Name:PROVIDED CARE IN HOME SERVICES, LLC.
Entity type:Organization
Organization Name:PROVIDED CARE IN HOME SERVICES, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:R
Authorized Official - Last Name:DOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-505-0383
Mailing Address - Street 1:217 E. STONE AVE SUITE 12
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29609
Mailing Address - Country:US
Mailing Address - Phone:864-200-2796
Mailing Address - Fax:864-569-0173
Practice Address - Street 1:217 E STONE AVE STE 12
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29609-5655
Practice Address - Country:US
Practice Address - Phone:864-200-2796
Practice Address - Fax:864-569-0173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-14
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1400033243251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCEX1222Medicaid