Provider Demographics
NPI:1790053064
Name:LOVE & FAITH HEALTH FOUNDATION INC
Entity Type:Organization
Organization Name:LOVE & FAITH HEALTH FOUNDATION INC
Other - Org Name:LOVE & FAITH HEALTH & FITNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DERRICK
Authorized Official - Middle Name:JACK
Authorized Official - Last Name:CUMBEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-264-2523
Mailing Address - Street 1:154 FREDDIE PL
Mailing Address - Street 2:
Mailing Address - City:ANDREWS
Mailing Address - State:SC
Mailing Address - Zip Code:29510-6524
Mailing Address - Country:US
Mailing Address - Phone:435-213-5549
Mailing Address - Fax:843-264-2523
Practice Address - Street 1:312 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ANDREWS
Practice Address - State:SC
Practice Address - Zip Code:29510-2642
Practice Address - Country:US
Practice Address - Phone:435-213-5549
Practice Address - Fax:843-264-2523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-01
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC261QC1500X, 261QH0100X, 261QP0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local