Healthcare Provider Details

I. General information

NPI: 1184195158
Provider Name (Legal Business Name): PRN HEALTHCARE STAFFING, LC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2018
Last Update Date: 01/18/2022
Certification Date: 01/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4325 DICK POND RD STE B
MYRTLE BEACH SC
29588-6810
US

IV. Provider business mailing address

4325 DICK POND RD STE B
MYRTLE BEACH SC
29588-6810
US

V. Phone/Fax

Practice location:
  • Phone: 843-353-4651
  • Fax: 866-446-4652
Mailing address:
  • Phone: 843-353-4651
  • Fax: 866-446-4652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number
License Number State
# 8
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: MRS. LATONYA D SANDERS-MILLER
Title or Position: PHLEBOTOMIST
Credential: RPT, CMA, NOTARY
Phone: 843-957-8782