# NURSE630 LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1841855582
- **Authorized official:** TYKEBA WILLIAMS (OWNER/ DIRECTOR)
- **Authorized official phone:** (864) 670-5267

## Contact information

- **Practice address:** 3505 PELHAM RD STE B, GREENVILLE, SC 29615-4154
- **Practice address phone:** (864) 670-5267
- **Mailing address:** 429 N IVESTOR CT, INMAN, SC 29349-7213
- **Mailing address phone:** (404) 821-7210

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 163WH0200X | Home Health Registered Nurse | — | NULL | — |
| 163WH0200X | Home Health Registered Nurse | — | — | — |
| 251E00000X | Home Health Agency | — | NULL | Yes |

## Other

- **Enumeration date:** 05/08/2019
- **Last updated:** 05/08/2019