Provider Demographics
NPI:1043985112
Name:PSW HOMECARE LLC
Entity Type:Organization
Organization Name:PSW HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:WOMMACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-716-5877
Mailing Address - Street 1:PO BOX 8175
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76714-8175
Mailing Address - Country:US
Mailing Address - Phone:254-716-5877
Mailing Address - Fax:
Practice Address - Street 1:144 GARRETT ST
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-3846
Practice Address - Country:US
Practice Address - Phone:803-418-5441
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-11
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care