Organization
NURSE630 LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TYKEBA WILLIAMS (OWNER/ DIRECTOR)
(864) 670-5267
Entity
Organization
Contact information
Practice address
3505 PELHAM RD STE B, GREENVILLE, SC 29615-4154
(864) 670-5267
Mailing address
429 N IVESTOR CT, INMAN, SC 29349-7213
(404) 821-7210
Taxonomy
Speciality
Code
Description
License number
State
163WH0200X
Home Health Registered Nurse
—
—
251E00000X
Home Health Agency
Primary
—
—
Other
Enumeration date
05/08/2019
Last updated
05/08/2019
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