Provider Demographics
NPI:1174769780
Name:PENCHANT COMPANION CARE SERVICES, LLC
Entity type:Organization
Organization Name:PENCHANT COMPANION CARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MONIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:KINARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-599-9468
Mailing Address - Street 1:2639 BOILING SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:BOILING SPRINGS
Mailing Address - State:SC
Mailing Address - Zip Code:29316-6011
Mailing Address - Country:US
Mailing Address - Phone:864-599-9468
Mailing Address - Fax:864-599-9676
Practice Address - Street 1:2639 BOILING SPRINGS RD
Practice Address - Street 2:
Practice Address - City:BOILING SPRINGS
Practice Address - State:SC
Practice Address - Zip Code:29316-6011
Practice Address - Country:US
Practice Address - Phone:864-599-9468
Practice Address - Fax:864-599-9676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-02
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCEX0812OtherMEDICAID CLTC