Healthcare Provider Details

I. General information

NPI: 1962713594
Provider Name (Legal Business Name): PALMETTO HEALTH SPECIAL CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2010
Last Update Date: 06/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 RICHLAND MEDICAL PARK DR STE 310
COLUMBIA SC
29203-6883
US

IV. Provider business mailing address

5 RICHLAND MEDICAL PARK DR
COLUMBIA SC
29203-6863
US

V. Phone/Fax

Practice location:
  • Phone: 803-434-2300
  • Fax: 803-434-8600
Mailing address:
  • Phone: 803-434-1310
  • Fax: 803-434-8600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License Number7208
License Number StateSC

VIII. Authorized Official

Name: MRS. JANICE DINKINS
Title or Position: DIRECTOR
Credential: RN
Phone: 803-434-1379