Provider Demographics
NPI:1710046271
Name:PALMETTO PERSONAL CARE SERVICES INC
Entity Type:Organization
Organization Name:PALMETTO PERSONAL CARE SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER SEC
Authorized Official - Prefix:MRS
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:POWERS
Authorized Official - Last Name:WILLIAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:910-649-6569
Mailing Address - Street 1:PO BOX 195
Mailing Address - Street 2:
Mailing Address - City:FAIR BLUFF
Mailing Address - State:NC
Mailing Address - Zip Code:28439
Mailing Address - Country:US
Mailing Address - Phone:910-649-6569
Mailing Address - Fax:910-649-6576
Practice Address - Street 1:684 MAIN ST
Practice Address - Street 2:
Practice Address - City:FAIR BLUFF
Practice Address - State:NC
Practice Address - Zip Code:28439
Practice Address - Country:US
Practice Address - Phone:910-649-6569
Practice Address - Fax:910-649-6576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6601053Medicaid
SCEX0697Medicaid
NC6601053Medicaid