Organization
EAU CLAIRE COOPERATIVE HEALTH CENTER, INC.
Active
Other names
Eau Claire Developmental Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DELGADO CANTAVE (CEO)
(803) 733-5969
Entity
Organization
Contact information
Practice address
4601 MONTICELLO ROAD, COLUMBIA, SC 29203
(803) 356-7102
(803) 356-7106
Mailing address
PO BOX 3788, COLUMBIA, SC 29230-3788
(803) 733-5969
(803) 753-5591
Taxonomy
Speciality
Code
Description
License number
State
2080P0006X
Developmental - Behavioral Pediatrics Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
CBP018
—
SC
05
—
FQC031
—
SC
05
—
FQC181
—
SC
Enumeration date
01/15/2015
Last updated
02/03/2022
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