1558342014 NPI number — COVENANT TOWERS HOMEOWNERS ASSOCIATION, INC.

Table of content: REBA FLOIS THOMPSON RD (NPI 1922095710)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558342014 NPI number — COVENANT TOWERS HOMEOWNERS ASSOCIATION, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COVENANT TOWERS HOMEOWNERS ASSOCIATION, 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:
6
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:
1558342014
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/29/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5001 LITTLE RIVER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MYRTLE BEACH
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29577-2478
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-449-2484
Provider Business Mailing Address Fax Number:
843-497-6238

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5001 LITTLE RIVER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MYRTLE BEACH
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29577-2478
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-449-2484
Provider Business Practice Location Address Fax Number:
843-497-6238
Provider Enumeration Date:
11/10/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HENDRICK
Authorized Official First Name:
DEBBIE
Authorized Official Middle Name:
M
Authorized Official Title or Position:
ASSOCIATE DIRECTOR
Authorized Official Telephone Number:
843-449-2484

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  NCF-469 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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