Healthcare Provider Details

I. General information

NPI: 1902176183
Provider Name (Legal Business Name): EAU CLAIRE COOPERATIVE HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2012
Last Update Date: 02/08/2021
Certification Date: 02/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9023 GARNERS FERRY RD
HOPKINS SC
29061-9540
US

IV. Provider business mailing address

PO BOX 3788
COLUMBIA SC
29230-3788
US

V. Phone/Fax

Practice location:
  • Phone: 803-978-1848
  • Fax: 803-978-1852
Mailing address:
  • Phone: 803-753-5591
  • Fax: 803-753-5591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DELGADO CANTAVE
Title or Position: CEO
Credential:
Phone: 803-733-5969