Provider Demographics
NPI:1770256133
Name:POTTERS OF EDEN , LLC
Entity type:Organization
Organization Name:POTTERS OF EDEN , LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:DESIREE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-345-2607
Mailing Address - Street 1:1 REAL ESTATE WAY # B14
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29302-1969
Mailing Address - Country:US
Mailing Address - Phone:864-345-2607
Mailing Address - Fax:864-428-1213
Practice Address - Street 1:1 REAL ESTATE WAY # B14
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29302-1969
Practice Address - Country:US
Practice Address - Phone:864-345-2607
Practice Address - Fax:864-428-1213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-30
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC86323797OtherIN HOME CARE SERVICE