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Organization

LC REHAB LLC

Active
Other names
Rehab Health Care
Organization subpart
No

Provider details

NPI number
Authorized official
MR. MAURY WISE COOKE JR. ATS CRTS (VICE PRESIDENT)
(757) 466-1553
Entity
Organization

Contact information

Practice address
5873 POPLAR HALL DRIVE, NORFOLK, VA 23502
(757) 466-1553
(757) 455-8536
Mailing address
5873 POPLAR HALL DRIVE, NORFOLK, VA 23502
(757) 466-1553
(757) 455-8536

Taxonomy

Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
010199816
VA
05
010207720
VA
01
186517
ANTHEM
VA
01
186532
ANTHEM
VA
01
99886
OPTIMA
Enumeration date
07/27/2006
Last updated
08/09/2013
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