Provider Demographics
NPI:1245684521
Name:PDS HOME HEALTH CARE AND MANAGEMENT
Entity type:Organization
Organization Name:PDS HOME HEALTH CARE AND MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED NURSE ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:PRINSCILLIA
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:SUMPTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-518-7238
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29476-0009
Mailing Address - Country:US
Mailing Address - Phone:843-518-7238
Mailing Address - Fax:
Practice Address - Street 1:109 CHILDRENS LANE
Practice Address - Street 2:
Practice Address - City:ST. STEPHENS
Practice Address - State:SC
Practice Address - Zip Code:29479-0109
Practice Address - Country:US
Practice Address - Phone:843-518-7238
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-22
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC116708305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service