Provider Demographics
NPI:1982812608
Name:LAKE CITY COMMUNITY DAY SERVICES, INC.
Entity type:Organization
Organization Name:LAKE CITY COMMUNITY DAY SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:EARLINE
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-374-8088
Mailing Address - Street 1:PO BOX 517
Mailing Address - Street 2:411 S BLANDING STREET
Mailing Address - City:LAKE CITY
Mailing Address - State:SC
Mailing Address - Zip Code:29560
Mailing Address - Country:US
Mailing Address - Phone:843-374-8088
Mailing Address - Fax:843-374-5388
Practice Address - Street 1:411 S BLANDING ST
Practice Address - Street 2:POB517
Practice Address - City:LAKE CITY
Practice Address - State:SC
Practice Address - Zip Code:29560-3513
Practice Address - Country:US
Practice Address - Phone:843-374-8088
Practice Address - Fax:843-374-5388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC5862700001Medicaid
SC5862700001Medicare PIN
SC5862700001Medicare NSC