Provider Demographics
NPI:1265850283
Name:LAURENS COUNTY HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:LAURENS COUNTY HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL NURSE
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:DIANNE
Authorized Official - Last Name:JETER
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:864-833-0000
Mailing Address - Street 1:93 HUMAN SERVICES RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:SC
Mailing Address - Zip Code:29325-7546
Mailing Address - Country:US
Mailing Address - Phone:864-833-0000
Mailing Address - Fax:
Practice Address - Street 1:93 HUMAN SERVICES RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:SC
Practice Address - Zip Code:29325-7546
Practice Address - Country:US
Practice Address - Phone:864-833-0000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-07
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLPN.21894 P251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare