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General NPI Number Information
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NPI Number | 1629015755
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Entity Type | Organization
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Legal Business Name | CARESOUTH CAROLINA, INC
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Dates
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Enumeration Date | 05/31/2006
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Last Update Date | 04/16/2021
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Provider Practice Location Address
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Address Line | 204 PERRY WILEY WAY
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City | CHESTERFIELD
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State | SC
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Zip | 29709-5701
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Country | US
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Telephone | 843-623-5080
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1090
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City | HARTSVILLE
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State | SC
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Zip | 29551-1090
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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 | CEO
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Name | ANN LEWIS
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Credential |
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Telephone | 843-857-0111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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