Provider Demographics
NPI:1316095300
Name:FIRST CALVARY BAPTIST CHURCH ADULT DAY CARE
Entity type:Organization
Organization Name:FIRST CALVARY BAPTIST CHURCH ADULT DAY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LARKIN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:HANCOCK
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:803-327-9181
Mailing Address - Street 1:PO BOX 164
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29731-0164
Mailing Address - Country:US
Mailing Address - Phone:803-327-9595
Mailing Address - Fax:803-985-4363
Practice Address - Street 1:228 LUCKY LANE
Practice Address - Street 2:
Practice Address - City:ROCK HI LL
Practice Address - State:SC
Practice Address - Zip Code:29730
Practice Address - Country:US
Practice Address - Phone:803-327-9595
Practice Address - Fax:803-985-4363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCADC154261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCEX0512Medicaid