Provider Demographics
NPI:1215154836
Name:EBENEZER SOCIAL ACTION AND COMMUNITY DEVELOPMENT ENTERPRISE
Entity type:Organization
Organization Name:EBENEZER SOCIAL ACTION AND COMMUNITY DEVELOPMENT ENTERPRISE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TARSHA
Authorized Official - Middle Name:LA'VET
Authorized Official - Last Name:WILLIAMS-MOSELEY
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:843-723-0065
Mailing Address - Street 1:44 NASSAU ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29403-5511
Mailing Address - Country:US
Mailing Address - Phone:843-723-0065
Mailing Address - Fax:843-723-0065
Practice Address - Street 1:44 NASSAU ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29403-5511
Practice Address - Country:US
Practice Address - Phone:843-723-0065
Practice Address - Fax:843-723-0065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCADC179311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility