Provider Demographics
NPI:1366712085
Name:LC REHAB LLC
Entity type:Organization
Organization Name:LC REHAB LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTING/OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LORRIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-802-9554
Mailing Address - Street 1:5873 POPLAR HALL DR
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-3815
Mailing Address - Country:US
Mailing Address - Phone:757-466-1553
Mailing Address - Fax:866-742-0760
Practice Address - Street 1:1717 ALLIED ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-5320
Practice Address - Country:US
Practice Address - Phone:434-971-8808
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-11
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA43016332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7704399Medicaid
VA010207720Medicaid
MD653101600Medicaid
VA5544020002Medicare NSC
NC7704399Medicaid