Provider Demographics
NPI:1922639558
Name:PALMETTO CORNER, LLC
Entity Type:Organization
Organization Name:PALMETTO CORNER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:RENSHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-881-5200
Mailing Address - Street 1:PO BOX 3640
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21802-3640
Mailing Address - Country:US
Mailing Address - Phone:410-881-5200
Mailing Address - Fax:
Practice Address - Street 1:12360 PALMETTO CHURCH RD
Practice Address - Street 2:
Practice Address - City:PRINCESS ANNE
Practice Address - State:MD
Practice Address - Zip Code:21853-4046
Practice Address - Country:US
Practice Address - Phone:410-881-5200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-02
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility