Organization
VISTELAN, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LARRY BRIAN PRIDEMORE (VP OF OPERATIONS)
(843) 771-0292
Entity
Organization
Contact information
Practice address
208 N CEDAR ST UNIT B, SUMMERVILLE, SC 29483-6451
(843) 771-0292
(888) 554-0253
Mailing address
208 N CEDAR ST UNIT B, SUMMERVILLE, SC 29483-6451
(843) 771-0292
(888) 554-0253
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
IHCP-0024
SC
Other
Enumeration date
06/09/2016
Last updated
06/09/2016
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