Provider Demographics
NPI:1871764902
Name:SOUTHWEST HOME CARELLC.
Entity type:Organization
Organization Name:SOUTHWEST HOME CARELLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:GARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:NONE
Authorized Official - Phone:276-565-1703
Mailing Address - Street 1:503 WEST MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:APPALCHIA
Mailing Address - State:VA
Mailing Address - Zip Code:24216
Mailing Address - Country:US
Mailing Address - Phone:276-565-1703
Mailing Address - Fax:
Practice Address - Street 1:503 W MAIN ST
Practice Address - Street 2:
Practice Address - City:APPALACHIA
Practice Address - State:VA
Practice Address - Zip Code:24216-1723
Practice Address - Country:US
Practice Address - Phone:276-565-1703
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-17
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0151693899Medicaid
VA0151694434Medicaid