Provider Demographics
NPI:1093002081
Name:SENECA HEALTHCARE, LLC
Entity Type:Organization
Organization Name:SENECA HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARRY
Authorized Official - Middle Name:K
Authorized Official - Last Name:VAN ROMER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:864-888-0039
Mailing Address - Street 1:555 BYPASS HIGHWAY 123
Mailing Address - Street 2:SUITE C
Mailing Address - City:SENECA
Mailing Address - State:SC
Mailing Address - Zip Code:29678-0809
Mailing Address - Country:US
Mailing Address - Phone:864-888-0039
Mailing Address - Fax:864-888-0034
Practice Address - Street 1:555 BYPASS HIGHWAY 123
Practice Address - Street 2:SUITE C
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29678-0809
Practice Address - Country:US
Practice Address - Phone:864-888-0039
Practice Address - Fax:864-888-0034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-29
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC6438940001Medicare NSC