Provider Demographics
NPI:1831929967
Name:PIVOT QUICKLY HOMECARE SEVICES LLC
Entity type:Organization
Organization Name:PIVOT QUICKLY HOMECARE SEVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRONODETTE
Authorized Official - Middle Name:D
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-376-4769
Mailing Address - Street 1:244 BASSWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ROEBUCK
Mailing Address - State:SC
Mailing Address - Zip Code:29376-2770
Mailing Address - Country:US
Mailing Address - Phone:864-376-4769
Mailing Address - Fax:
Practice Address - Street 1:1518 JOHN B WHITE SR BLVD STE 6
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29301-3837
Practice Address - Country:US
Practice Address - Phone:864-376-4769
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-05
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care