Healthcare Provider Details

I. General information

NPI: 1679404156
Provider Name (Legal Business Name): PALM GROVE REGIONAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 MARKET ST
CHERAW SC
29520-2636
US

IV. Provider business mailing address

415 MARKET ST
CHERAW SC
29520-2636
US

V. Phone/Fax

Practice location:
  • Phone: 843-213-6170
  • Fax:
Mailing address:
  • Phone: 843-213-6170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SUSAN HAYES
Title or Position: CREDENTIALING
Credential: CPC
Phone: 843-292-0600