Provider Demographics
NPI:1255747283
Name:EAST COOPER WELLNESS
Entity type:Organization
Organization Name:EAST COOPER WELLNESS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:LUCKIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-571-3100
Mailing Address - Street 1:3741 TIDELAND DR
Mailing Address - Street 2:
Mailing Address - City:JOHNS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29455-7456
Mailing Address - Country:US
Mailing Address - Phone:843-425-4694
Mailing Address - Fax:843-766-7798
Practice Address - Street 1:1965 RIVIERA DR
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-7469
Practice Address - Country:US
Practice Address - Phone:843-571-3100
Practice Address - Fax:843-766-7798
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WEST ASHLEY WELLNESS & REHABILITATION, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-07-10
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23765225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1962726117OtherNPI FOR WEST ASHLEY WELLNESS & REHABILITATION, LLC
SC1962726117OtherNPI FOR WEST ASHLEY WELLNESS & REHABILITATION, LLC