Healthcare Provider Details

I. General information

NPI: 1942753827
Provider Name (Legal Business Name): LIVING ON PURPOSE EVERYDAY-L.O.P.E
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2016
Last Update Date: 07/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 MOCKINGBIRD DR
LEXINGTON SC
29073-8739
US

IV. Provider business mailing address

110 MOCKINGBIRD DR
LEXINGTON SC
29073-8739
US

V. Phone/Fax

Practice location:
  • Phone: 803-237-1403
  • Fax:
Mailing address:
  • Phone: 803-237-1403
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License NumberC85707
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number100295992
License Number StateSC

VIII. Authorized Official

Name: LEAH ANTUNES
Title or Position: C.E.O
Credential:
Phone: 803-237-1403