Healthcare Provider Details

I. General information

NPI: 1316498264
Provider Name (Legal Business Name): PERFECT LOVE TRANSPORT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2016
Last Update Date: 10/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2634 WHIRLAWAY AVE
FLORENCE SC
29505-8720
US

IV. Provider business mailing address

2634 WHIRLAWAY AVE
FLORENCE SC
29505-8720
US

V. Phone/Fax

Practice location:
  • Phone: 843-453-8165
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number004914709
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number008080303
License Number StateSC

VIII. Authorized Official

Name: PATRICIA ANN ROUSE
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 843-453-8165