1396446787 NPI number — RHONDA LOUANNE RAWDON

Table of content: (NPI 1396446787)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396446787 NPI number — RHONDA LOUANNE RAWDON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RHONDA LOUANNE RAWDON
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
COSMOS LIVING C/O RHONDA LOUANNE RAWDON-COUCH
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396446787
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/29/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1048 CROATOAN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCK HILL
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29730-9626
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-207-6756
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1048 CROATOAN DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCK HILL
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29730-9626
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-207-6756
Provider Business Practice Location Address Fax Number:
866-412-6766
Provider Enumeration Date:
03/14/2023

Additional Information

Authorized Official

Authorized Official Last Name:
COUCH
Authorized Official First Name:
RHONDA
Authorized Official Middle Name:
LOUANNE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
803-207-6756

Provider Taxonomy Codes

  • Taxonomy code: 164W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251J00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QA0600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QD1600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3104A0630X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 313M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 320600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 320900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 385H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1396446787 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: EY1208 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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