Healthcare Provider Details

I. General information

NPI: 1174662134
Provider Name (Legal Business Name): MARLBORO ADULT CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1039 CHERAW STREET
BENNETTSVILLE SC
29512-2422
US

IV. Provider business mailing address

PO BOX 1484 1039 CHERAW STREET
BENNETTSVILLE SC
29512-2422
US

V. Phone/Fax

Practice location:
  • Phone: 843-479-0603
  • Fax: 843-479-0081
Mailing address:
  • Phone: 843-479-0603
  • Fax: 843-479-0081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberADC 243
License Number StateSC

VIII. Authorized Official

Name: MS. DENISE P WASHINGTON
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 843-479-0603