MEDICARE: II CORINTHIANS 5:17 INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	2077	SC
2	251V00000X	Voluntary or Charitable Agency	2077	SC

General Provider Information

NPI Number	:	1760787824
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	II CORINTHIANS 5:17 INC

Provider Business Mailing Address
First Line	:	PO BOX 2310
Second Line	:
City	:	GREENWOOD
State	:	SC
Zip	:	29646-0310
Country	:	US
Telephone Number	:	864-337-2445
Fax Number	:

Provider Business Practice Location Address
First Line	:	1043 PHOENIX ST
Second Line	:
City	:	GREENWOOD
State	:	SC
Zip	:	29646-3915
Country	:	US
Telephone Number	:	864-337-2445
Fax Number	:

Authorized Official
Title or Position	:	C.E.O.
Name	:	MR. KENNETH MEDOWS
Credential	:	BUISNESS MGMT
Telephone Number	:	864-337-2445

Provider Enumeration Date	:	01/21/2011
Last Update Date	:	01/21/2011

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