Provider Demographics
NPI:1992099659
Name:PALMETTO HOMECARE
Entity type:Organization
Organization Name:PALMETTO HOMECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:864-221-2980
Mailing Address - Street 1:780 TILLOTSON RD
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-5105
Mailing Address - Country:US
Mailing Address - Phone:864-221-2980
Mailing Address - Fax:864-296-6911
Practice Address - Street 1:780 TILLOTSON RD
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-5105
Practice Address - Country:US
Practice Address - Phone:864-221-2980
Practice Address - Fax:864-296-6911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-30
Last Update Date:2011-07-27
Deactivation Date:2011-06-13
Deactivation Code:
Reactivation Date:2011-07-27
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment