Provider Demographics
NPI:1124863105
Name:PALMETTO IN HOMERN
Entity type:Organization
Organization Name:PALMETTO IN HOMERN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:L
Authorized Official - Last Name:IRIZARRY
Authorized Official - Suffix:
Authorized Official - Credentials:MSN RN
Authorized Official - Phone:843-637-6814
Mailing Address - Street 1:525 FOLLY RD STE 207
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-3008
Mailing Address - Country:US
Mailing Address - Phone:843-637-6814
Mailing Address - Fax:
Practice Address - Street 1:525 FOLLY RD STE 207
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412-3008
Practice Address - Country:US
Practice Address - Phone:843-637-6814
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No251E00000XAgenciesHome Health
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty