Healthcare Provider Details

I. General information

NPI: 1205017860
Provider Name (Legal Business Name): HOPE CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5880 RIVERS AVE
NORTH CHARLESTON SC
29406
US

IV. Provider business mailing address

5880 RIVERS AVE
NORTH CHARLESTON SC
29406-6053
US

V. Phone/Fax

Practice location:
  • Phone: 843-725-4673
  • Fax: 843-725-1235
Mailing address:
  • Phone: 843-725-4673
  • Fax: 843-725-1235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number20234
License Number StateSC

VIII. Authorized Official

Name: DR. TEMISAN L ETIKERENTSE
Title or Position: MEDICAL DOCTOR, CEO
Credential: M.D
Phone: 843-725-4673