Healthcare Provider Details

I. General information

NPI: 1790053064
Provider Name (Legal Business Name): LOVE & FAITH HEALTH FOUNDATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2011
Last Update Date: 05/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 E MAIN ST
ANDREWS SC
29510-2642
US

IV. Provider business mailing address

154 FREDDIE PL
ANDREWS SC
29510-6524
US

V. Phone/Fax

Practice location:
  • Phone: 435-213-5549
  • Fax: 843-264-2523
Mailing address:
  • Phone: 435-213-5549
  • Fax: 843-264-2523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code261QP0905X
TaxonomyState or Local Public Health Clinic/Center
License Number
License Number StateSC

VIII. Authorized Official

Name: MR. DERRICK JACK CUMBEE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 843-264-2523