Healthcare Provider Details

I. General information

NPI: 1932023553
Provider Name (Legal Business Name): INITIATIVE HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 BLANDING ST STE 4
COLUMBIA SC
29201-2922
US

IV. Provider business mailing address

1415 BLANDING ST STE 4
COLUMBIA SC
29201-2922
US

V. Phone/Fax

Practice location:
  • Phone: 803-779-7500
  • Fax: 803-779-7522
Mailing address:
  • Phone: 803-779-7500
  • Fax: 803-779-7522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: PENNY M LOYA
Title or Position: NURSE PRACTITIONER
Credential: FNP-BC
Phone: 803-779-7503