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General NPI Number Information
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NPI Number | 1205988607
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Entity Type | Organization
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Legal Business Name | L C REHAB LLC
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 08/09/2013
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Provider Practice Location Address
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Address Line | 2135 STAPLES MILL RD
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City | RICHMOND
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State | VA
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Zip | 23230-2905
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Country | US
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Telephone | 804-353-7244
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Fax | 804-353-5976
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Provider Business Mailing Address
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Address Line | 5873 POPLAR HALL DR
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City | NORFOLK
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State | VA
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Zip | 23502-3815
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Country | US
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Telephone | 757-466-1553
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Fax | 757-455-8536
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MR. MAURY WISE COOKE JR.
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Credential |
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Telephone | 757-466-1553
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | 043016L14460
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License Number State | VA
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