Provider Demographics
NPI:1194472910
Name:PALMETTO GOODWILL
Entity Type:Organization
Organization Name:PALMETTO GOODWILL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ITZKOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-566-0072
Mailing Address - Street 1:2150 EAGLE DR
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-4803
Mailing Address - Country:US
Mailing Address - Phone:843-566-0072
Mailing Address - Fax:843-806-3288
Practice Address - Street 1:2150 EAGLE DR
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-4803
Practice Address - Country:US
Practice Address - Phone:843-566-0072
Practice Address - Fax:843-806-3288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-02
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services