Healthcare Provider Details

I. General information

NPI: 1801643846
Provider Name (Legal Business Name): CERTINURSE HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2024
Last Update Date: 05/06/2024
Certification Date: 05/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

371 HILLBROOK CIR
PACOLET SC
29372-2435
US

IV. Provider business mailing address

371 HILLBROOK CIR
PACOLET SC
29372-2435
US

V. Phone/Fax

Practice location:
  • Phone: 864-327-5310
  • Fax:
Mailing address:
  • Phone: 864-327-5310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State

VIII. Authorized Official

Name: MS. ADELIA FEASTER SMITH
Title or Position: REGISTERED NURSE
Credential: RN
Phone: 864-327-5310