Provider Demographics
NPI:1568114999
Name:IT'S YOUR MOVE
Entity type:Organization
Organization Name:IT'S YOUR MOVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEENEKA
Authorized Official - Middle Name:LACHELLE
Authorized Official - Last Name:BEACH-PHELPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-471-9865
Mailing Address - Street 1:425 SUMMIT TERRACE CT STE 7B
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-7055
Mailing Address - Country:US
Mailing Address - Phone:877-471-9865
Mailing Address - Fax:803-335-5343
Practice Address - Street 1:425 SUMMIT TERRACE CT STE 7B
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-7055
Practice Address - Country:US
Practice Address - Phone:877-471-9865
Practice Address - Fax:803-335-5343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-26
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP8718Medicaid