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General NPI Number Information
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NPI Number | 1720618408
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Entity Type | Individual
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Provider Name | MARILYN LEE
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Gender | Female
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Dates
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Enumeration Date | 01/22/2020
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Last Update Date | 01/22/2020
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Provider Practice Location Address
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Address Line | 4716 THOROUGHBRED DR
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City | N CHARLESTON
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State | SC
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Zip | 29420-7581
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Country | US
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Telephone | 973-462-2510
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 50844
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City | SUMMERVILLE
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State | SC
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Zip | 29485-0844
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Country | US
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Telephone | 973-462-2510
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 26NH12675200
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License Number State | NJ
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