Provider Demographics
NPI:1386696839
Name:KERSHAW COUNTY ADULT DAY CARE CENTER
Entity type:Organization
Organization Name:KERSHAW COUNTY ADULT DAY CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:P
Authorized Official - Last Name:CARLTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-425-9040
Mailing Address - Street 1:PO BOX 331
Mailing Address - Street 2:2204 N BROAD STREET
Mailing Address - City:CAMDEN
Mailing Address - State:SC
Mailing Address - Zip Code:29020
Mailing Address - Country:US
Mailing Address - Phone:803-425-9040
Mailing Address - Fax:803-425-9041
Practice Address - Street 1:2204 N BROAD STREET
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:SC
Practice Address - Zip Code:29020
Practice Address - Country:US
Practice Address - Phone:803-425-9040
Practice Address - Fax:803-425-9041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCEX0364Medicaid