MEDICARE: MRS. CHERRELLE LAMIKA FERGUSON

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	251E00000X	Home Health Agency		SC

General Provider Information

NPI Number	:	1255850459
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHERRELLE LAMIKA FERGUSON

Provider Business Mailing Address
First Line	:	125 LIONS CLUB RD APT 213
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29617-2137
Country	:	US
Telephone Number	:	864-436-3256
Fax Number	:

Provider Business Practice Location Address
First Line	:	125 LIONS CLUB RD APT 213
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29617-2137
Country	:	US
Telephone Number	:	864-436-3256
Fax Number	:

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

Provider Enumeration Date	:	09/19/2017
Last Update Date	:	07/21/2022

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