Provider Demographics
NPI:1730852914
Name:OWENS, CHARITY
Entity type:Individual
Prefix:
First Name:CHARITY
Middle Name:
Last Name:OWENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 HERITAGE PKWY
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-4451
Mailing Address - Country:US
Mailing Address - Phone:678-573-9073
Mailing Address - Fax:
Practice Address - Street 1:104 BUCKWALTER PKWY STE 2E
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-4129
Practice Address - Country:US
Practice Address - Phone:678-573-9073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-26
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
372500000X, 374U00000X, 376J00000X, 251E00000X, 376J00000X
SC372600000X, 372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
No372500000XNursing Service Related ProvidersChore Provider
No374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker
Yes251E00000XAgenciesHome Health