Provider Demographics
NPI:1811347792
Name:TUPELO POND LLC
Entity type:Organization
Organization Name:TUPELO POND LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TERREL
Authorized Official - Middle Name:L
Authorized Official - Last Name:STEINLICHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-225-2067
Mailing Address - Street 1:3623 OLD CHARLESTON HWY
Mailing Address - Street 2:SUITE 14
Mailing Address - City:JOHNS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29455-7827
Mailing Address - Country:US
Mailing Address - Phone:843-225-2067
Mailing Address - Fax:843-225-2690
Practice Address - Street 1:3623 OLD CHARLESTON HWY
Practice Address - Street 2:SUITE 14
Practice Address - City:JOHNS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29455-7827
Practice Address - Country:US
Practice Address - Phone:843-225-2067
Practice Address - Fax:843-225-2690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-21
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCIHCP-0282253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care