Provider Demographics
NPI:1760787824
Name:II CORINTHIANS 5:17 INC
Entity Type:Organization
Organization Name:II CORINTHIANS 5:17 INC
Other - Org Name:CENTER STAGE COMMUNITY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDOWS
Authorized Official - Suffix:
Authorized Official - Credentials:BUISNESS MGMT
Authorized Official - Phone:864-337-2445
Mailing Address - Street 1:PO BOX 2310
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29646-0310
Mailing Address - Country:US
Mailing Address - Phone:864-337-2445
Mailing Address - Fax:
Practice Address - Street 1:1043 PHOENIX ST
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-3915
Practice Address - Country:US
Practice Address - Phone:864-337-2445
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-21
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2077251S00000X, 251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
No251S00000XAgenciesCommunity/Behavioral Health