Healthcare Provider Details

I. General information

NPI: 1245143916
Provider Name (Legal Business Name): ROCKY'S CROWN & GLORY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1309 LANTERN RD
SUMMERVILLE SC
29486-2087
US

IV. Provider business mailing address

507 FRONT ST
SUMMERVILLE SC
29486-7919
US

V. Phone/Fax

Practice location:
  • Phone: 513-690-7589
  • Fax:
Mailing address:
  • Phone: 513-690-7589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State

VIII. Authorized Official

Name: TOWELA NJAMBA
Title or Position: OWNER
Credential: CEO
Phone: 513-690-7589