Provider Demographics
NPI:1285316232
Name:MYRTLE HEALTHCARE, LLC
Entity type:Organization
Organization Name:MYRTLE HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARINZE
Authorized Official - Middle Name:
Authorized Official - Last Name:NWOZOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-219-6152
Mailing Address - Street 1:277 LIGHTHOUSE DR
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94590-4030
Mailing Address - Country:US
Mailing Address - Phone:925-219-6615
Mailing Address - Fax:
Practice Address - Street 1:277 LIGHTHOUSE DR
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-4030
Practice Address - Country:US
Practice Address - Phone:925-219-6615
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-01
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health