MEDICARE: FAITHFUL ADULT DAYCARE SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA0600X	Adult Day Care Clinic/Center	ADC-0420	SC

General Provider Information

NPI Number	:	1194231191
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAITHFUL ADULT DAYCARE SERVICES, LLC

Provider Business Mailing Address
First Line	:	21 SAINT MATTHEWS RD
Second Line	:
City	:	ST MATTHEWS
State	:	SC
Zip	:	29135-8400
Country	:	US
Telephone Number	:	803-655-5002
Fax Number	:	803-655-5001

Provider Business Practice Location Address
First Line	:	21 SAINT MATTHEWS RD
Second Line	:
City	:	ST MATTHEWS
State	:	SC
Zip	:	29135-8400
Country	:	US
Telephone Number	:	803-655-5002
Fax Number	:	803-655-5001

Authorized Official
Title or Position	:	PRINCIPAL
Name	:	BETTYE RAVENELL
Credential	:
Telephone Number	:	803-655-5002

Provider Enumeration Date	:	12/28/2017
Last Update Date	:	12/28/2017

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