Individual
ROOSEVELT STACKHOUSE JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
1705 W EVANS ST, FLORENCE, SC 29501-3331
(843) 774-1577
(843) 774-1047
Mailing address
PO BOX 648, 521 GILCHRIST ROAD, MULLINS, SC 29574-0648
(843) 464-0767
(843) 464-0767
Taxonomy
Speciality
Code
Description
License number
State
163WH0200X
Home Health Registered Nurse
Primary
37318
SC
Other
Enumeration date
03/18/2014
Last updated
03/18/2014
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