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General NPI Number Information
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NPI Number | 1366712085
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Entity Type | Organization
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Legal Business Name | LC REHAB LLC
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Dates
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Enumeration Date | 01/11/2012
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Last Update Date | 01/11/2012
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Provider Practice Location Address
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Address Line | 1717 ALLIED ST
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22903-5320
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Country | US
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Telephone | 434-971-8808
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Fax |
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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 | 866-742-0760
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Authorized Official
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Title or Position | ACCOUNTING/OFFICE MANAGER
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Name | LORRIE A EDWARDS
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Credential |
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Telephone | 757-802-9554
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 43016
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License Number State | VA
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