1033566781 NPI number — LEADING LADIES EMPOWERMENT, INC.

Table of content: (NPI 1033566781)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033566781 NPI number — LEADING LADIES EMPOWERMENT, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LEADING LADIES EMPOWERMENT, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033566781
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/14/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4611 HARD SCRABBLE RD # 109-280
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29229-8584
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-902-3537
Provider Business Mailing Address Fax Number:
803-419-8787

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
309 ROLLING KNOLL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29229-9299
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-626-8300
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/23/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BROOKS
Authorized Official First Name:
EBONY
Authorized Official Middle Name:
D
Authorized Official Title or Position:
PRESIDENT/EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
803-297-1619

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  2016-49730-48648 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 2016-49730-48648 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 252Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)