Provider Demographics
NPI:1083440812
Name:99ONE HEALTHCARE, LLC
Entity type:Organization
Organization Name:99ONE HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:DESTRY
Authorized Official - Last Name:JETER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-544-7440
Mailing Address - Street 1:496 BRAMSON CT UNIT 160A
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-7961
Mailing Address - Country:US
Mailing Address - Phone:479-544-7440
Mailing Address - Fax:
Practice Address - Street 1:496 BRAMSON CT UNIT 160A
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-7961
Practice Address - Country:US
Practice Address - Phone:479-544-7440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health