Provider Demographics
NPI:1841980141
Name:HOME AT LAST 4EVER, LLC
Entity type:Organization
Organization Name:HOME AT LAST 4EVER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHORNALYN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-254-4443
Mailing Address - Street 1:245 LAGO CIR APT 203
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-3372
Mailing Address - Country:US
Mailing Address - Phone:843-254-4443
Mailing Address - Fax:
Practice Address - Street 1:2752 CALVARY RD.
Practice Address - Street 2:
Practice Address - City:HARTSVILLE
Practice Address - State:FL
Practice Address - Zip Code:29550-2955
Practice Address - Country:US
Practice Address - Phone:843-254-4443
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-10
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care