Provider Demographics
NPI:1073676565
Name:LOUVENIA D BARKSDALE SICKLE CELL FOUNDATION
Entity type:Organization
Organization Name:LOUVENIA D BARKSDALE SICKLE CELL FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:LENNETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAY BREWTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-582-9420
Mailing Address - Street 1:POST OFFICE BOX 191
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29304
Mailing Address - Country:US
Mailing Address - Phone:864-582-9420
Mailing Address - Fax:894-582-9421
Practice Address - Street 1:645 S CHURCH ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29306-5301
Practice Address - Country:US
Practice Address - Phone:864-582-9420
Practice Address - Fax:864-582-9421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2007-07-24
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2007-07-24
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCMC0010Medicare UPIN