Healthcare Provider Details

I. General information

NPI: 1528981610
Provider Name (Legal Business Name): PROMISE SOURCE HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12544 MAIN ST
WILLISTON SC
29853-2704
US

IV. Provider business mailing address

12544 MAIN ST
WILLISTON SC
29853-2704
US

V. Phone/Fax

Practice location:
  • Phone: 803-240-6648
  • Fax: 803-240-6648
Mailing address:
  • Phone: 803-240-6648
  • Fax: 803-240-6648

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: STEVEN BROWN
Title or Position: OWNER
Credential: BROWN
Phone: 803-240-6648