Provider Demographics
NPI:1942044649
Name:FULLIFE HOPE CENTER
Entity type:Organization
Organization Name:FULLIFE HOPE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LAKESHA
Authorized Official - Middle Name:LOLITA
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-372-2386
Mailing Address - Street 1:PO BOX 12241
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29731-2241
Mailing Address - Country:US
Mailing Address - Phone:803-372-2386
Mailing Address - Fax:
Practice Address - Street 1:508 CHERRY RD S
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-3436
Practice Address - Country:US
Practice Address - Phone:839-500-3387
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-19
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care