Provider Demographics
NPI:1588237101
Name:ALLEN, REBECCA JANE
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:JANE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:378 S PINE ST APT 5
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29302-2653
Mailing Address - Country:US
Mailing Address - Phone:864-596-8804
Mailing Address - Fax:
Practice Address - Street 1:378 S PINE ST APT 5
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29302-2653
Practice Address - Country:US
Practice Address - Phone:864-596-8804
Practice Address - Fax:864-596-8849
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-21
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCIHCP-0894253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care