Healthcare Provider Details

I. General information

NPI: 1396798419
Provider Name (Legal Business Name): PALMETTO HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 10/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 TAYLOR AT MARION STREET
COLUMBIA SC
29201-0001
US

IV. Provider business mailing address

PO BOX 402141
ATLANTA GA
30384-2141
US

V. Phone/Fax

Practice location:
  • Phone: 803-296-2548
  • Fax: 803-296-7950
Mailing address:
  • Phone: 803-296-2548
  • Fax: 803-296-7950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberHTL739
License Number StateSC

VIII. Authorized Official

Name: MR. THOMAS B ECKERT
Title or Position: CORPORATE DIRECTOR
Credential: CPAM
Phone: 803-296-2254