Healthcare Provider Details

I. General information

NPI: 1548699028
Provider Name (Legal Business Name): ALPHA & OMEGA EMPOWERMENT FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2013
Last Update Date: 11/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2813 SHADBLOW LN UNIT 1306
WEST COLUMBIA SC
29170-3180
US

IV. Provider business mailing address

2813 SHADBLOW LN UNIT 1306
WEST COLUMBIA SC
29170-3180
US

V. Phone/Fax

Practice location:
  • Phone: 843-433-1128
  • Fax:
Mailing address:
  • Phone: 843-433-1128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number000000000
License Number State

VIII. Authorized Official

Name: MRS. MARY ANN HODGE
Title or Position: CEO
Credential:
Phone: 843-433-1128