=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740086230
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PINKNEY FAMILY FIRST LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/24/2025
-----------------------------------------------------
Last Update Date | 02/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 80 SAMPSON RD
-----------------------------------------------------
City | HEMINGWAY
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29554-6151
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-709-8137
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6942 HIGHWAY 162
-----------------------------------------------------
City | HOLLYWOOD
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29449-6710
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-299-4937
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE ASSISTANT
-----------------------------------------------------
Name | MR. GERARD ROURK COLTER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 704-299-4937
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------