MEDICARE: LARESSA H JAMES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	385HR2060X	Child Intellectual and/or Developmental Disabilities Respite Care	0236	SC

General Provider Information

NPI Number	:	1245919091
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARESSA H JAMES

Provider Business Mailing Address
First Line	:	4805 ANDERSON ST
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29203-4203
Country	:	US
Telephone Number	:	803-201-7323
Fax Number	:

Provider Business Practice Location Address
First Line	:	4805 ANDERSON ST
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29203-4203
Country	:	US
Telephone Number	:	803-201-7323
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2023
Last Update Date	:	07/17/2023

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