Provider Demographics
NPI:1386058329
Name:AHAVA CARE MANAGEMENT, LLC
Entity type:Organization
Organization Name:AHAVA CARE MANAGEMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CCO
Authorized Official - Prefix:
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-240-5399
Mailing Address - Street 1:7505 IRMO DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29212-8637
Mailing Address - Country:US
Mailing Address - Phone:803-240-5399
Mailing Address - Fax:803-791-1634
Practice Address - Street 1:7505 IRMO DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29212-8637
Practice Address - Country:US
Practice Address - Phone:803-240-5399
Practice Address - Fax:803-791-1634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-18
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management