Provider Demographics
NPI:1114325768
Name:PRICE, LISA
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:PRICE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 SPRING CREEK CT
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-7948
Mailing Address - Country:US
Mailing Address - Phone:803-920-6148
Mailing Address - Fax:
Practice Address - Street 1:213 SPRING CREEK CT
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-7948
Practice Address - Country:US
Practice Address - Phone:803-920-6148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-15
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC163WH0200XOtherFIRSTLIGHT HOMECARE OF COLUMBIA, SOUTH CAROLINA