Organization
CARESOUTH CAROLINA INC
Active
Organization
CARESOUTH CAROLINA INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANN M LEWIS (CEO)
(843) 857-0111
Entity
Organization
Contact information
Practice address
122 LATIMER ST, LATTA, SC 29565-1828
(843) 857-0111
Mailing address
122 LATIMER ST, LATTA, SC 29565-1828
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
FQC197
—
SC
Enumeration date
05/01/2015
Last updated
06/15/2016
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