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General NPI Number Information
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NPI Number | 1841855582
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Entity Type | Organization
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Legal Business Name | NURSE630 LLC
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Dates
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Enumeration Date | 05/08/2019
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Last Update Date | 05/08/2019
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Provider Practice Location Address
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Address Line | 3505 PELHAM RD STE B
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City | GREENVILLE
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State | SC
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Zip | 29615-4154
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Country | US
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Telephone | 864-670-5267
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Fax |
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Provider Business Mailing Address
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Address Line | 429 N IVESTOR CT
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City | INMAN
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State | SC
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Zip | 29349-7213
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Country | US
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Telephone | 404-821-7210
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Fax |
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Authorized Official
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Title or Position | OWNER/ DIRECTOR
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Name | TYKEBA WILLIAMS
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Credential |
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Telephone | 864-670-5267
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WH0200X
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Taxonomy Name | Home Health Registered Nurse
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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