Provider Demographics
NPI:1144001298
Name:L.R. SHAW'S PERFECT PIECE, LLC
Entity type:Organization
Organization Name:L.R. SHAW'S PERFECT PIECE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/BCBA
Authorized Official - Prefix:
Authorized Official - First Name:LACEY
Authorized Official - Middle Name:REKKA
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:843-697-9894
Mailing Address - Street 1:PO BOX 8021
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29604-8021
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:635 FARRS BRIDGE RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29611-1862
Practice Address - Country:US
Practice Address - Phone:843-697-9894
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-12
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities