Provider Demographics
NPI:1871920744
Name:HEALTH EDUCATION RESOURCE OUTREACH COMMUNITY SERVICES LLC
Entity type:Organization
Organization Name:HEALTH EDUCATION RESOURCE OUTREACH COMMUNITY SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/COMMUNITY HEALTH COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LOUNZY
Authorized Official - Middle Name:ANTWAN
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:843-267-7044
Mailing Address - Street 1:2842 FARMER BROWN CT
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579-3219
Mailing Address - Country:US
Mailing Address - Phone:843-267-7044
Mailing Address - Fax:
Practice Address - Street 1:2842 FARMER BROWN CT
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29579-3219
Practice Address - Country:US
Practice Address - Phone:843-267-7044
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-08
Last Update Date:2013-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health