Healthcare Provider Details

I. General information

NPI: 1558300293
Provider Name (Legal Business Name): COMMUNITY LIFE-LINK,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 08/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4504 E HIGHWAY 76
MULLINS SC
29574-7261
US

IV. Provider business mailing address

4504 E HIGHWAY 76
MULLINS SC
29574-7261
US

V. Phone/Fax

Practice location:
  • Phone: 843-464-4307
  • Fax: 866-375-0088
Mailing address:
  • Phone: 843-464-4307
  • Fax: 866-375-0088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. BERNARD GERALD
Title or Position: CEO
Credential:
Phone: 843-464-4307