Provider Demographics
NPI:1144099490
Name:ZELLARS, LORETTA
Entity type:Individual
Prefix:
First Name:LORETTA
Middle Name:
Last Name:ZELLARS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7720 LINSLEY DR
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29418-3230
Mailing Address - Country:US
Mailing Address - Phone:843-330-9126
Mailing Address - Fax:
Practice Address - Street 1:7720 LINSLEY DR
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29418-3230
Practice Address - Country:US
Practice Address - Phone:843-330-9126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-28
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC174200000X, 332U00000X, 372600000X, 3747P1801X, 376J00000X
SC153871376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty
No174200000XOther Service ProvidersMeals
No332U00000XSuppliersHome Delivered Meals
No372600000XNursing Service Related ProvidersAdult Companion
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No376J00000XNursing Service Related ProvidersHomemaker