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General NPI Number Information
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NPI Number | 1548466923
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Entity Type | Organization
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Legal Business Name | EXCHANGE CLUB CENTER
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Dates
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Enumeration Date | 06/22/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1092 E MONTAGUE AVE
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City | NORTH CHARLESTON
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State | SC
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Zip | 29405-4837
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Country | US
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Telephone | 843-747-1339
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Fax |
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Provider Business Mailing Address
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Address Line | 1092 E MONTAGUE AVE
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City | NORTH CHARLESTON
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State | SC
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Zip | 29405-4837
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | MS. LATANYA FISHER
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Credential |
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Telephone | 843-747-1339
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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