Provider Demographics
NPI:1396261095
Name:SCHHA, LLC
Entity type:Organization
Organization Name:SCHHA, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ENRICO
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:BALLEZZI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-575-3206
Mailing Address - Street 1:4300 HADDONFIELD RD
Mailing Address - Street 2:
Mailing Address - City:PENNSAUKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08109-3376
Mailing Address - Country:US
Mailing Address - Phone:973-909-5159
Mailing Address - Fax:
Practice Address - Street 1:1117 48TH AVE N STE 125
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-5442
Practice Address - Country:US
Practice Address - Phone:843-492-6602
Practice Address - Fax:843-492-6609
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BAYADA HOME CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-08-15
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCHHA351Medicaid