MEDICARE: PALMETTO HOME HEALTH, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1154159135
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALMETTO HOME HEALTH, LLC

Provider Business Mailing Address
First Line	:	5115 N DYSART RD
Second Line	:	STE 202, UNIT#193
City	:	LITCHFIELD PARK
State	:	AZ
Zip	:	85340
Country	:	US
Telephone Number	:	602-510-8627
Fax Number	:

Provider Business Practice Location Address
First Line	:	871 VENETIA BAY BLVD STE 227
Second Line	:
City	:	VENICE
State	:	FL
Zip	:	34285-8049
Country	:	US
Telephone Number	:	602-510-8627
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	PAUL ANTHONY KESSLER
Credential	:
Telephone Number	:	602-510-8627

Provider Enumeration Date	:	07/23/2024
Last Update Date	:	07/23/2024

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