Healthcare Provider Details

I. General information

NPI: 1154159135
Provider Name (Legal Business Name): PALMETTO HOME HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2024
Last Update Date: 07/23/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

871 VENETIA BAY BLVD STE 227
VENICE FL
34285-8049
US

IV. Provider business mailing address

5115 N DYSART RD STE 202, UNIT#193
LITCHFIELD PARK AZ
85340
US

V. Phone/Fax

Practice location:
  • Phone: 602-510-8627
  • Fax:
Mailing address:
  • Phone: 602-510-8627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: PAUL ANTHONY KESSLER
Title or Position: CEO
Credential:
Phone: 602-510-8627