Provider Demographics
NPI:1609055037
Name:PALMETTO HOME CARE UPSTATE, LLC
Entity Type:Organization
Organization Name:PALMETTO HOME CARE UPSTATE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:AUSTIN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:864-272-1973
Mailing Address - Street 1:1990 AUGUSTA ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-2997
Mailing Address - Country:US
Mailing Address - Phone:864-272-1973
Mailing Address - Fax:864-272-1974
Practice Address - Street 1:1990 AUGUSTA ST
Practice Address - Street 2:SUITE 204
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-2997
Practice Address - Country:US
Practice Address - Phone:864-272-1973
Practice Address - Fax:864-272-1974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-01
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health