Provider Demographics
NPI:1235337767
Name:LYMPHEDEMA AND REHAB CENTER, LLC
Entity Type:Organization
Organization Name:LYMPHEDEMA AND REHAB CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:NOURSE
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:864-934-0423
Mailing Address - Street 1:PO BOX 42
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29622-0042
Mailing Address - Country:US
Mailing Address - Phone:864-934-0423
Mailing Address - Fax:864-226-3015
Practice Address - Street 1:1701 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-4761
Practice Address - Country:US
Practice Address - Phone:864-934-0423
Practice Address - Fax:864-226-3015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0558332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1023175601OtherINDIVIDUAL