Organization
LC REHAB LLC
Active
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
Update your record
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