Provider Demographics
NPI:1235733809
Name:NEXT LEVEL FITNESS & BOXING
Entity Type:Organization
Organization Name:NEXT LEVEL FITNESS & BOXING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF BOOK KEEPER
Authorized Official - Prefix:MR
Authorized Official - First Name:LENOLA
Authorized Official - Middle Name:LAVERNE
Authorized Official - Last Name:COOKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-278-5563
Mailing Address - Street 1:1059 TODD AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29841-4451
Mailing Address - Country:US
Mailing Address - Phone:803-278-5563
Mailing Address - Fax:
Practice Address - Street 1:738 E MARTINTOWN RD
Practice Address - Street 2:
Practice Address - City:NORTH AUGUSTA
Practice Address - State:SC
Practice Address - Zip Code:29841-4288
Practice Address - Country:US
Practice Address - Phone:803-292-2480
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services