Healthcare Provider Details

I. General information

NPI: 1225207988
Provider Name (Legal Business Name): MY MOTHERS KEEPER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2008
Last Update Date: 02/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1265 HAMLIN RD
MT PLEASANT SC
29464
US

IV. Provider business mailing address

PO BOX 2522
MT PLEASANT SC
29465
US

V. Phone/Fax

Practice location:
  • Phone: 843-870-1839
  • Fax:
Mailing address:
  • Phone: 843-870-1839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number120514E
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number120514E
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number120514E
License Number StateSC

VIII. Authorized Official

Name: MRS. JACQUELYN MARIE JACKSON
Title or Position: CERTIFIED NURSES ASSISTANT
Credential:
Phone: 843-870-1839