Provider Demographics
NPI:1730117177
Name:JOLEN LLC
Entity Type:Organization
Organization Name:JOLEN LLC
Other - Org Name:UPSTATE MEDICAL & MOBILITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JO
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HODGES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-582-8998
Mailing Address - Street 1:PO BOX 1371
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29304-1371
Mailing Address - Country:US
Mailing Address - Phone:864-582-8998
Mailing Address - Fax:864-582-8993
Practice Address - Street 1:2114 CHESNEE HWY
Practice Address - Street 2:SUITE C
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-2521
Practice Address - Country:US
Practice Address - Phone:864-582-8998
Practice Address - Fax:864-582-8993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-28
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDE18S5Medicaid
SC5313780001Medicare NSC