Provider Demographics
NPI:1417560293
Name:E&L COLONIAL LLC
Entity Type:Organization
Organization Name:E&L COLONIAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:CO OWNER
Authorized Official - Phone:843-800-0123
Mailing Address - Street 1:1156 BOWMAN RD UNIT 200
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3858
Mailing Address - Country:US
Mailing Address - Phone:843-800-0123
Mailing Address - Fax:843-800-0601
Practice Address - Street 1:1156 BOWMAN RD UNIT 200
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3858
Practice Address - Country:US
Practice Address - Phone:843-800-0123
Practice Address - Fax:843-800-0601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-31
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCIHCP-0695OtherDHEC IN HOME CARE PROVIDER LICENSE