Healthcare Provider Details

I. General information

NPI: 1043985112
Provider Name (Legal Business Name): PSW HOMECARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2021
Last Update Date: 08/11/2021
Certification Date: 08/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 GARRETT ST
SUMTER SC
29150-3846
US

IV. Provider business mailing address

PO BOX 8175
WACO TX
76714-8175
US

V. Phone/Fax

Practice location:
  • Phone: 803-418-5441
  • Fax:
Mailing address:
  • Phone: 254-716-5877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: PAUL WOMMACK
Title or Position: OWNER
Credential:
Phone: 254-716-5877