Provider Demographics
NPI:1508342072
Name:LALA'S HOME HEALTHCARE,LLC
Entity type:Organization
Organization Name:LALA'S HOME HEALTHCARE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:RITA
Authorized Official - Middle Name:RENITA
Authorized Official - Last Name:FENNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-539-8623
Mailing Address - Street 1:PO BOX 871
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29449-0871
Mailing Address - Country:US
Mailing Address - Phone:843-539-8623
Mailing Address - Fax:
Practice Address - Street 1:5291 MAIN NURSERY RD
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:SC
Practice Address - Zip Code:29449-6708
Practice Address - Country:US
Practice Address - Phone:843-539-8623
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-17
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY589205770OtherHOME HEALTHCARE