Provider Demographics
NPI:1356106512
Name:LAZY WAKES LLC
Entity type:Organization
Organization Name:LAZY WAKES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHARMARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GURLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-212-2016
Mailing Address - Street 1:7168 WEDDINGTON RD NW STE 140
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-3472
Mailing Address - Country:US
Mailing Address - Phone:704-212-2016
Mailing Address - Fax:
Practice Address - Street 1:7168 WEDDINGTON RD NW STE 140
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-3472
Practice Address - Country:US
Practice Address - Phone:704-212-2016
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-16
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies