Provider Demographics
NPI:1073802633
Name:JOHNSONVILLE ADULT DAY CENTER
Entity type:Organization
Organization Name:JOHNSONVILLE ADULT DAY CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:HART
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-380-0777
Mailing Address - Street 1:P.O. BOX 1118
Mailing Address - Street 2:
Mailing Address - City:JOHNSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29555-1118
Mailing Address - Country:US
Mailing Address - Phone:843-380-0777
Mailing Address - Fax:843-380-1531
Practice Address - Street 1:351 S. MIDWAY HIGHWAY
Practice Address - Street 2:
Practice Address - City:JOHNSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29555
Practice Address - Country:US
Practice Address - Phone:843-380-0777
Practice Address - Fax:843-380-1531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-05
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC343900000X
SCADC0298261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)