Provider Demographics
NPI:1083458087
Name:SDS PREFERRED HOME CARE AGENCY
Entity type:Organization
Organization Name:SDS PREFERRED HOME CARE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DORETHA
Authorized Official - Middle Name:SHANTE
Authorized Official - Last Name:DONALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-614-7812
Mailing Address - Street 1:1014A PEACHTREE ST
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35901-3968
Mailing Address - Country:US
Mailing Address - Phone:717-614-7812
Mailing Address - Fax:
Practice Address - Street 1:SD PREFERRED HOME CARE AGENCY
Practice Address - Street 2:1014A PEACHTREE ST
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:17109
Practice Address - Country:US
Practice Address - Phone:717-614-7812
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171400000XOther Service ProvidersHealth & Wellness CoachGroup - Single Specialty