MEDICARE: PALMETTO HUMAN RESOURCES 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	HC3913	NC
2	253Z00000X	In Home Supportive Care Agency		SC

General Provider Information

NPI Number	:	1578905220
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALMETTO HUMAN RESOURCES LLC

Provider Business Mailing Address
First Line	:	3009 CHURCH ST
Second Line	:	SUITE B
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29577-5983
Country	:	US
Telephone Number	:	843-249-9200
Fax Number	:	843-249-3931

Provider Business Practice Location Address
First Line	:	3009 CHURCH ST
Second Line	:	SUITE B
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29577-5983
Country	:	US
Telephone Number	:	843-249-9200
Fax Number	:	843-249-3931

Authorized Official
Title or Position	:	OWNER
Name	:	MR. SCOTT MALLORY
Credential	:
Telephone Number	:	843-249-9200

Provider Enumeration Date	:	07/23/2013
Last Update Date	:	07/23/2013

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