NPIMap

Organization Active NPI

Community Life-Link,LLC

  • Durable Medical Equipment & Medical Supplies
  • Mullins, SC
National Provider Identifier
1558300293
Registry record updated Aug 13, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
COMMUNITY LIFE-LINK,LLC
Doing business as
Community Life-Link, LLC
Practice address
4504 E Highway 76
Mullins, SC 29574-7261
Phone
(843) 464-4307
Fax
(866) 375-0088
NPI assigned
Jun 6, 2006
Last updated
Aug 13, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Bernard Gerald
Title
Ceo
Phone
(843) 464-4307

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nursing Care Agency 251J00000X
Durable Medical Equipment & Medical Supplies 332B00000X Primary

Addresses

Primary practice location

4504 E Highway 76
Mullins, SC 29574-7261

Mailing address

4504 E Highway 76
Mullins, SC 29574-7261
Phone (843) 464-4307

Other identifiers 3

IdentifierTypeStateIssuer
EN0987MedicaidSC
DE1248MedicaidSC
EN2031MedicaidSC

Other names 1

  • Community Life-Link, LLC Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Community Life-Linkllc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149552000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1344816000000",
    "number": "1558300293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4504 E HIGHWAY 76",
            "city": "MULLINS",
            "state": "SC",
            "postal_code": "295747261",
            "telephone_number": "843-464-4307",
            "fax_number": "866-375-0088"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4504 E HIGHWAY 76",
            "city": "MULLINS",
            "state": "SC",
            "postal_code": "295747261",
            "telephone_number": "843-464-4307",
            "fax_number": "866-375-0088"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY LIFE-LINK,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-06",
        "last_updated": "2012-08-13",
        "status": "A",
        "authorized_official_last_name": "GERALD",
        "authorized_official_first_name": "BERNARD",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "843-464-4307",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251J00000X",
            "taxonomy_group": "",
            "desc": "Nursing Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "EN0987",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "DE1248",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "EN2031",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Community Life-Link, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mullins, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.