Basic Information
Provider Information | |||||||||
NPI: | 1780343400 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | SCHHA, LLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | MUSC HEALTH HOSPICE AT HOME BY BAYADA - CHARLESTON | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 4300 HADDONFIELD RD | ||||||||
Address2: |   | ||||||||
City: | PENNSAUKEN | ||||||||
State: | NJ | ||||||||
PostalCode: | 081093376 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9739095159 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 1671 BELLE ISLE AVE STE 115C | ||||||||
Address2: |   | ||||||||
City: | MOUNT PLEASANT | ||||||||
State: | SC | ||||||||
PostalCode: | 294648336 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8434164020 | ||||||||
FaxNumber: | 8434164021 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/09/2021 | ||||||||
LastUpdateDate: | 05/24/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | BALLEZZI | ||||||||
AuthorizedOfficialFirstName: | ENRICO | ||||||||
AuthorizedOfficialMiddleName: | JOSEPH | ||||||||
AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
AuthorizedOfficialTelephone: | 6093921900 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | Y | ||||||||
ParentOrganizationLBN: | SCHHA, LLC | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 05/24/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X |   |   | N |   | Agencies | Home Health |   | 251G00000X |   |   | Y |   | Agencies | Hospice Care, Community Based |   |
No ID Information.