Provider Demographics
NPI:1487122768
Name:EKKLESIA HOME CARE LLC
Entity type:Organization
Organization Name:EKKLESIA HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAMELLA
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-818-9240
Mailing Address - Street 1:3262 LANDMARK DR STE 127
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29418-8588
Mailing Address - Country:US
Mailing Address - Phone:843-225-2634
Mailing Address - Fax:843-225-2635
Practice Address - Street 1:3262 LANDMARK DR STE 127
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29418-8588
Practice Address - Country:US
Practice Address - Phone:843-225-2634
Practice Address - Fax:843-225-2635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-05
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care