Provider Demographics
NPI:1891374112
Name:AUTHENTIC PEARLS LLC
Entity Type:Organization
Organization Name:AUTHENTIC PEARLS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:PEARSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-310-4681
Mailing Address - Street 1:PO BOX 1194
Mailing Address - Street 2:
Mailing Address - City:TAYLORS
Mailing Address - State:SC
Mailing Address - Zip Code:29687-0025
Mailing Address - Country:US
Mailing Address - Phone:832-276-6702
Mailing Address - Fax:
Practice Address - Street 1:102 METRO DR STE 15
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-2754
Practice Address - Country:US
Practice Address - Phone:864-310-4681
Practice Address - Fax:864-754-4145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-05
Last Update Date:2021-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCEX1982Medicaid