Healthcare Provider Details

I. General information

NPI: 1629353305
Provider Name (Legal Business Name): LIFECYCLE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2011
Last Update Date: 10/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 WHITSETT ST
GREENVILLE SC
29601-3137
US

IV. Provider business mailing address

PO BOX 26209
GREENVILLE SC
29616-1209
US

V. Phone/Fax

Practice location:
  • Phone: 864-234-6979
  • Fax: 864-281-0553
Mailing address:
  • Phone: 864-234-6979
  • Fax: 864-281-0553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN BRIAN FERGUSON
Title or Position: PRESIDENT
Credential:
Phone: 864-234-6979