MEDICARE: PALMETTO HOME HEALTHCARE

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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1194361857
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALMETTO HOME HEALTHCARE

Provider Business Mailing Address
First Line	:	1335 RONALD LN
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29412-8227
Country	:	US
Telephone Number	:	843-297-5179
Fax Number	:	843-795-7317

Provider Business Practice Location Address
First Line	:	1335 RONALD LN
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29412-8227
Country	:	US
Telephone Number	:	843-297-5179
Fax Number	:	843-795-7317

Authorized Official
Title or Position	:	CEO
Name	:	MISS AUDRY WILLIAMS
Credential	:	MSN BSN RN
Telephone Number	:	843-297-5179

Provider Enumeration Date	:	11/18/2019
Last Update Date	:	11/18/2019

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