MEDICARE: LALA'S HOME HEALTHCARE,LLC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	589205770	OTHER	NY	HOME HEALTHCARE

General Provider Information

NPI Number	:	1508342072
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LALA'S HOME HEALTHCARE,LLC

Provider Business Mailing Address
First Line	:	PO BOX 871
Second Line	:
City	:	HOLLYWOOD
State	:	SC
Zip	:	29449-0871
Country	:	US
Telephone Number	:	843-539-8623
Fax Number	:

Provider Business Practice Location Address
First Line	:	5291 MAIN NURSERY RD
Second Line	:
City	:	HOLLYWOOD
State	:	SC
Zip	:	29449-6708
Country	:	US
Telephone Number	:	843-539-8623
Fax Number	:

Authorized Official
Title or Position	:	OWNER/OPERATOR
Name	:	RITA RENITA FENNELL
Credential	:
Telephone Number	:	843-539-8623

Provider Enumeration Date	:	07/17/2018
Last Update Date	:	07/17/2018

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