Organization
L C REHAB LLC
Active
Other names
REHAB HEALTH CARE
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MAURY WISE COOKE JR. (VICE PRESIDENT)
(757) 466-1553
Entity
Organization
Contact information
Practice address
2135 STAPLES MILL RD, RICHMOND, VA 23230-2905
(804) 353-7244
(804) 353-5976
Mailing address
5873 POPLAR HALL DR, NORFOLK, VA 23502-3815
(757) 466-1553
(757) 455-8536
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
043016L14460
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010207720
—
VA
01
—
186532
ANTHEM
VA
05
—
7704399
—
NC
Enumeration date
01/17/2007
Last updated
08/09/2013
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