Healthcare Provider Details

I. General information

NPI: 1215154836
Provider Name (Legal Business Name): EBENEZER SOCIAL ACTION AND COMMUNITY DEVELOPMENT ENTERPRISE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 NASSAU ST
CHARLESTON SC
29403-5511
US

IV. Provider business mailing address

44 NASSAU ST
CHARLESTON SC
29403-5511
US

V. Phone/Fax

Practice location:
  • Phone: 843-723-0065
  • Fax: 843-723-0065
Mailing address:
  • Phone: 843-723-0065
  • Fax: 843-723-0065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License NumberADC179
License Number StateSC

VIII. Authorized Official

Name: MS. TARSHA LA'VET WILLIAMS-MOSELEY
Title or Position: DIRECTOR
Credential: MA
Phone: 843-723-0065