1376020669 NPI number — PALMETTO HOME CARE SERVICE, LLC

Table of content: DR. ROBERT G BUCHLA D.C. (NPI 1588847164)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376020669 NPI number — PALMETTO HOME CARE SERVICE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PALMETTO HOME CARE SERVICE, 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:
1376020669
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/06/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
879 NE MAIN ST STE B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SIMPSONVILLE
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29681-2056
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-962-3085
Provider Business Mailing Address Fax Number:
865-962-3095

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
134 BORDER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SIMPSONVILLE
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29680-7388
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-438-0560
Provider Business Practice Location Address Fax Number:
864-228-7799
Provider Enumeration Date:
07/19/2018

Additional Information

Authorized Official

Authorized Official Last Name:
HALL
Authorized Official First Name:
BRANDI
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
864-962-3085

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 253Z00000X , with the licence number: 26552 , 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)

  • Identifier: EX1743 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com