Provider Demographics
NPI:1194767673
Name:SARAH ANNS UNDERCOVER WORLD OF EASLEY, INC
Entity type:Organization
Organization Name:SARAH ANNS UNDERCOVER WORLD OF EASLEY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:STANSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-968-1699
Mailing Address - Street 1:14324 E WADE HAMPTON BLVD
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29651-1542
Mailing Address - Country:US
Mailing Address - Phone:864-968-1699
Mailing Address - Fax:864-968-5048
Practice Address - Street 1:611 E WADE HAMPTON BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29651-1547
Practice Address - Country:US
Practice Address - Phone:864-968-1699
Practice Address - Fax:864-968-5048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC042502032332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0551840001Medicare ID - Type UnspecifiedPROVIDER NUMBER