Provider Demographics
NPI:1346950243
Name:LUCAS ANGELS
Entity Type:Organization
Organization Name:LUCAS ANGELS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LATOYA
Authorized Official - Middle Name:BRYANT
Authorized Official - Last Name:LUCAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-861-5197
Mailing Address - Street 1:432 KINGSTON DR
Mailing Address - Street 2:
Mailing Address - City:MC BEE
Mailing Address - State:SC
Mailing Address - Zip Code:29101-9568
Mailing Address - Country:US
Mailing Address - Phone:843-319-7330
Mailing Address - Fax:
Practice Address - Street 1:432 KINGSTON DR
Practice Address - Street 2:
Practice Address - City:MC BEE
Practice Address - State:SC
Practice Address - Zip Code:29101-9568
Practice Address - Country:US
Practice Address - Phone:843-319-7330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-01
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health