Provider Demographics
NPI:1396076857
Name:COLUMBIA ADULT CARE ON MAIN
Entity type:Organization
Organization Name:COLUMBIA ADULT CARE ON MAIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:M
Authorized Official - Last Name:QUARLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-212-7005
Mailing Address - Street 1:3127 ROSEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29205-3434
Mailing Address - Country:US
Mailing Address - Phone:803-212-7005
Mailing Address - Fax:803-212-7005
Practice Address - Street 1:2101 MAIN ST STE H
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2159
Practice Address - Country:US
Practice Address - Phone:803-212-7005
Practice Address - Fax:803-212-7005
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COLUMBIA ADULT CARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-01-23
Last Update Date:2010-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCADC0292385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care