Provider Demographics
NPI:1568073849
Name:DELTA PALMS ASSISTED LIVING LLC
Entity Type:Organization
Organization Name:DELTA PALMS ASSISTED LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:L
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-753-3920
Mailing Address - Street 1:2314 OLD HIGHWAY 6
Mailing Address - Street 2:
Mailing Address - City:CROSS
Mailing Address - State:SC
Mailing Address - Zip Code:29436-3548
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12488 OLD NUMBER SIX HWY # 6
Practice Address - Street 2:
Practice Address - City:EUTAWVILLE
Practice Address - State:SC
Practice Address - Zip Code:29048-9167
Practice Address - Country:US
Practice Address - Phone:843-670-6051
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-11
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility