Healthcare Provider Details

I. General information

NPI: 1295618106
Provider Name (Legal Business Name): COVERED BY CHUKWU
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2025
Last Update Date: 08/17/2025
Certification Date: 08/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 STARLING RD
MULLINS SC
29574-7330
US

IV. Provider business mailing address

3535 STARLING RD
MULLINS SC
29574-7330
US

V. Phone/Fax

Practice location:
  • Phone: 843-591-4546
  • Fax:
Mailing address:
  • Phone: 843-591-4546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code282J00000X
TaxonomyReligious Nonmedical Health Care Institution
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code374K00000X
TaxonomyReligious Nonmedical Practitioner
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code374T00000X
TaxonomyReligious Nonmedical Nursing Personnel
License Number
License Number State

VIII. Authorized Official

Name: SHARAI ROSE MONTGOMERY
Title or Position: OUTREACH AND EQUITY DIRECTOR
Credential:
Phone: 843-591-4546