Healthcare Provider Details

I. General information

NPI: 1992178586
Provider Name (Legal Business Name): STEP BY STEPS COMMUNITY LYNX, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2015
Last Update Date: 11/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730C BROAD ST
SUMTER SC
29150-3356
US

IV. Provider business mailing address

730C BROAD ST
SUMTER SC
29150-3356
US

V. Phone/Fax

Practice location:
  • Phone: 704-701-0836
  • Fax:
Mailing address:
  • Phone: 704-701-0836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number000000000
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number000000001
License Number StateSC

VIII. Authorized Official

Name: WILLIBA BROGDON
Title or Position: CFO
Credential:
Phone: 704-701-0836