Provider Demographics
NPI:1053928333
Name:HOME CARE DIRECT, LLC
Entity type:Organization
Organization Name:HOME CARE DIRECT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:B
Authorized Official - Last Name:WIGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:184-335-8200
Mailing Address - Street 1:PO BOX 645
Mailing Address - Street 2:
Mailing Address - City:AYNOR
Mailing Address - State:SC
Mailing Address - Zip Code:29511-0645
Mailing Address - Country:US
Mailing Address - Phone:184-335-8200
Mailing Address - Fax:
Practice Address - Street 1:242 8TH AVE
Practice Address - Street 2:
Practice Address - City:AYNOR
Practice Address - State:SC
Practice Address - Zip Code:29511-3222
Practice Address - Country:US
Practice Address - Phone:184-335-8200
Practice Address - Fax:843-358-2007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-30
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCEX0718Medicaid