Provider Demographics
NPI:1568486959
Name:LC REHAB LLC
Entity Type:Organization
Organization Name:LC REHAB LLC
Other - Org Name:REHAB HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MAURY
Authorized Official - Middle Name:WISE
Authorized Official - Last Name:COOKE
Authorized Official - Suffix:JR
Authorized Official - Credentials:ATS CRTS
Authorized Official - Phone:757-466-1553
Mailing Address - Street 1:5873 POPLAR HALL DRIVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502
Mailing Address - Country:US
Mailing Address - Phone:757-466-1553
Mailing Address - Fax:757-455-8536
Practice Address - Street 1:5873 POPLAR HALL DRIVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502
Practice Address - Country:US
Practice Address - Phone:757-466-1553
Practice Address - Fax:757-455-8536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA186532OtherANTHEM
99886OtherOPTIMA
VA186517OtherANTHEM
VA010207720Medicaid
VA010199816Medicaid
VA010207720Medicaid
99886OtherOPTIMA
VA010207720Medicaid