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General NPI Number Information
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NPI Number | 1114368842
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Entity Type | Organization
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Legal Business Name | PALMETTO PERSONAL & SENIOR CARE
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Dates
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Enumeration Date | 07/10/2013
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Last Update Date | 07/10/2013
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Provider Practice Location Address
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Address Line | 16 WILLOW WIND LN
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City | HOPKINS
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State | SC
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Zip | 29061-9689
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Country | US
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Telephone | 803-543-6179
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Fax |
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Provider Business Mailing Address
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Address Line | 16 WILLOW WIND LN
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City | HOPKINS
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State | SC
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Zip | 29061-9689
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Country | US
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Telephone | 803-543-6179
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. RONYAL LENARD WATSON SR.
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Credential |
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Telephone | 803-543-6179
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 45196-44251
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License Number State | SC
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