MEDICARE: PALMETTO FAMILY HOMECARE, 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	251B00000X	Case Management Agency
2	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1356739387
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALMETTO FAMILY HOMECARE, LLC

Provider Business Mailing Address
First Line	:	4000 FABER PLACE DR
Second Line	:	SUITE 327
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29405-8585
Country	:	US
Telephone Number	:	843-509-5207
Fax Number	:	843-323-4271

Provider Business Practice Location Address
First Line	:	4000 FABER PLACE DR
Second Line	:	SUITE 327
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29405-8585
Country	:	US
Telephone Number	:	843-509-5207
Fax Number	:	843-323-4271

Authorized Official
Title or Position	:	REGIONAL DIRECTOR
Name	:	MRS. SYLVIA STEWART
Credential	:
Telephone Number	:	843-509-5207

Provider Enumeration Date	:	12/29/2014
Last Update Date	:	12/29/2014

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