1104960871 NPI number — PALMETTO HOSPICE, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104960871 NPI number — PALMETTO HOSPICE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PALMETTO HOSPICE, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104960871
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1204 LEXINGTON ST
Provider Second Line Business Mailing Address:
SUITE 2A
Provider Business Mailing Address City Name:
IRMO
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29063-2862
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-749-9120
Provider Business Mailing Address Fax Number:
803-749-9128

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1204 LEXINGTON AVENUE
Provider Second Line Business Practice Location Address:
SUITE 2A
Provider Business Practice Location Address City Name:
IRMO
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29063-2862
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-749-9120
Provider Business Practice Location Address Fax Number:
803-749-9128
Provider Enumeration Date:
02/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
OLSEN
Authorized Official First Name:
ANGELA
Authorized Official Middle Name:
DUNN
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
803-749-9120

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , with the licence number:  HPC-117 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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