Healthcare Provider Details

I. General information

NPI: 1639410202
Provider Name (Legal Business Name): BELVEDERE ELEMENTARY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2013
Last Update Date: 03/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 RHOMBOID PL
NORTH AUGUSTA SC
29841-2635
US

IV. Provider business mailing address

201 RHOMBOID PL
NORTH AUGUSTA SC
29841-2635
US

V. Phone/Fax

Practice location:
  • Phone: 803-442-6330
  • Fax: 803-442-6131
Mailing address:
  • Phone: 803-442-6330
  • Fax: 803-442-6131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number214152
License Number StateSC

VIII. Authorized Official

Name: ALISON CHURM
Title or Position: PRINCIPAL
Credential:
Phone: 803-442-6330