Provider Demographics
NPI:1831172907
Name:SOUTH COUNTY HOME HEALTH
Entity type:Organization
Organization Name:SOUTH COUNTY HOME HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, SOUTH COUNTY HOME HEAALTH
Authorized Official - Prefix:
Authorized Official - First Name:ANSJE
Authorized Official - Middle Name:
Authorized Official - Last Name:GERSHKOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, RN, CMC
Authorized Official - Phone:401-788-2330
Mailing Address - Street 1:14 WOODRUFF AVE
Mailing Address - Street 2:SUITE 7
Mailing Address - City:NARRAGANSETT
Mailing Address - State:RI
Mailing Address - Zip Code:02882-3467
Mailing Address - Country:US
Mailing Address - Phone:401-782-0500
Mailing Address - Fax:401-788-2311
Practice Address - Street 1:14 WOODRUFF AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:NARRAGANSETT
Practice Address - State:RI
Practice Address - Zip Code:02882-3467
Practice Address - Country:US
Practice Address - Phone:401-782-0500
Practice Address - Fax:401-788-2311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-22
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIRI417023Medicaid
RIRI417023Medicaid