Healthcare Provider Details

I. General information

NPI: 1821394313
Provider Name (Legal Business Name): RUDENE JACKSON BUDHOO EXECUTIVE DIRECTOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2011
Last Update Date: 02/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 KENNEDY RD
WINNSBORO SC
29180-5906
US

IV. Provider business mailing address

14 KENNEDY RD
WINNSBORO SC
29180-5906
US

V. Phone/Fax

Practice location:
  • Phone: 803-635-2736
  • Fax: 803-633-8187
Mailing address:
  • Phone: 803-635-2736
  • Fax: 803-633-8187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: