| Chichora Life Center | |
|
3600 Rivers Ave North Charleston SC 29405-7747 | |
| (843) 772-4112 | |
| Not Available |
| Full Name | Chichora Life Center |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 3600 Rivers Ave, North Charleston, South Carolina |
| Authorized Official Name and Position | Reuben Pettiford (CEO) |
| Authorized Official Contact | 8437224112 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Chichora Life Center 51 Nassau St Charleston SC 29403-5513 Ph: (843) 722-4112 | Chichora Life Center 3600 Rivers Ave North Charleston SC 29405-7747 Ph: (843) 772-4112 |
| NPI Number | 1336528504 |
|---|---|
| Provider Enumeration Date | 05/21/2015 |
| Last Update Date | 05/21/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336528504 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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