Provider Demographics
NPI:1538216841
Name:COLUMBIA URBAN LEAGUE, INC.
Entity type:Organization
Organization Name:COLUMBIA URBAN LEAGUE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:T
Authorized Official - Last Name:MCLAWHORN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:803-799-8150
Mailing Address - Street 1:1400 BARNWELL ST
Mailing Address - Street 2:P.O. BOX 50125
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-3512
Mailing Address - Country:US
Mailing Address - Phone:803-799-8150
Mailing Address - Fax:803-254-6052
Practice Address - Street 1:1400 BARNWELL ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-3512
Practice Address - Country:US
Practice Address - Phone:803-799-8150
Practice Address - Fax:803-254-6052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCMC0053171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty