Provider Demographics
NPI:1184195158
Name:PRN HEALTHCARE STAFFING, LC
Entity Type:Organization
Organization Name:PRN HEALTHCARE STAFFING, LC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHLEBOTOMIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:LATONYA
Authorized Official - Middle Name:D
Authorized Official - Last Name:SANDERS-MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:RPT, CMA, NOTARY
Authorized Official - Phone:843-957-8782
Mailing Address - Street 1:4325 DICK POND RD STE B
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29588-6810
Mailing Address - Country:US
Mailing Address - Phone:843-353-4651
Mailing Address - Fax:866-446-4652
Practice Address - Street 1:4325 DICK POND RD STE B
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29588-6810
Practice Address - Country:US
Practice Address - Phone:843-353-4651
Practice Address - Fax:866-446-4652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-17
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
No251E00000XAgenciesHome Health
No251S00000XAgenciesCommunity/Behavioral Health
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No302F00000XManaged Care OrganizationsExclusive Provider Organization
No305S00000XManaged Care OrganizationsPoint of Service
No335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
No347C00000XTransportation ServicesPrivate Vehicle