Provider Demographics
NPI:1881895829
Name:COMMUNITY LIFE-LINK, LLC
Entity type:Organization
Organization Name:COMMUNITY LIFE-LINK, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:
Authorized Official - Last Name:GERALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-464-4307
Mailing Address - Street 1:4504 E HIGHWAY 76
Mailing Address - Street 2:
Mailing Address - City:MULLINS
Mailing Address - State:SC
Mailing Address - Zip Code:29574-7261
Mailing Address - Country:US
Mailing Address - Phone:843-464-4307
Mailing Address - Fax:866-375-0088
Practice Address - Street 1:4504 E HIGHWAY 76
Practice Address - Street 2:
Practice Address - City:MULLINS
Practice Address - State:SC
Practice Address - Zip Code:29574-7261
Practice Address - Country:US
Practice Address - Phone:843-464-4307
Practice Address - Fax:866-375-0088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDE3184Medicaid
SCEN2031Medicaid
SCDE1248Medicaid