Provider Demographics
NPI:1053293324
Name:SUPPORT PRIVATE DUTY CARE
Entity type:Organization
Organization Name:SUPPORT PRIVATE DUTY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:RUFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-639-7752
Mailing Address - Street 1:PO BOX 158
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38556-0158
Mailing Address - Country:US
Mailing Address - Phone:866-970-8111
Mailing Address - Fax:
Practice Address - Street 1:1416 TAYLOR PLACE ROAD
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:TN
Practice Address - Zip Code:38556
Practice Address - Country:US
Practice Address - Phone:866-970-8111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-25
Last Update Date:2025-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health