Healthcare Provider Details

I. General information

NPI: 1295629525
Provider Name (Legal Business Name): LIFECYCLE II, LLC DBA IMA INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2025
Last Update Date: 06/19/2025
Certification Date: 06/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 PARK RD
CHARLOTTE NC
28209-2388
US

IV. Provider business mailing address

531 S MAIN ST STE 300
GREENVILLE SC
29601-2556
US

V. Phone/Fax

Practice location:
  • Phone: 704-529-4411
  • Fax:
Mailing address:
  • Phone: 803-269-7330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY SUMMERS
Title or Position: NURSE
Credential: RN
Phone: 803-269-7330