MEDICARE: PALMETTO HOME CARE UPSTATE, 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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1578218582
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALMETTO HOME CARE UPSTATE, LLC

Provider Business Mailing Address
First Line	:	25 WOODS LAKE RD STE 301
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29607-2762
Country	:	US
Telephone Number	:	864-272-1973
Fax Number	:

Provider Business Practice Location Address
First Line	:	25 WOODS LAKE RD STE 301
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29607-2762
Country	:	US
Telephone Number	:	864-272-1973
Fax Number	:	864-272-1973

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. VICTOR AUSTIN JR.
Credential	:
Telephone Number	:	864-272-1973

Provider Enumeration Date	:	02/17/2022
Last Update Date	:	02/17/2022

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