Provider Demographics
NPI:1992758049
Name:ESPECIALLY FOR HER, LLC
Entity type:Organization
Organization Name:ESPECIALLY FOR HER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SCARLETT
Authorized Official - Middle Name:
Authorized Official - Last Name:LUTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-317-1881
Mailing Address - Street 1:209 S GRIFFIN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29506-2860
Mailing Address - Country:US
Mailing Address - Phone:843-679-3356
Mailing Address - Fax:843-679-3376
Practice Address - Street 1:209 S GRIFFIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2860
Practice Address - Country:US
Practice Address - Phone:843-679-3356
Practice Address - Fax:843-679-3376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDE2644Medicaid
SC5522260001Medicare NSC
SCDE2644Medicaid