1073676565 NPI number — LOUVENIA D BARKSDALE SICKLE CELL FOUNDATION

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073676565 NPI number — LOUVENIA D BARKSDALE SICKLE CELL FOUNDATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOUVENIA D BARKSDALE SICKLE CELL FOUNDATION
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:
1073676565
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/24/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
07/17/2007
NPI Reactivation Date:
07/24/2007

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
POST OFFICE BOX 191
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPARTANBURG
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29304
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-582-9420
Provider Business Mailing Address Fax Number:
894-582-9421

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
645 S CHURCH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPARTANBURG
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29306-5301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-582-9420
Provider Business Practice Location Address Fax Number:
864-582-9421
Provider Enumeration Date:
12/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GRAY BREWTON
Authorized Official First Name:
LENNETTA
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
864-582-9420

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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