Healthcare Provider Details

I. General information

NPI: 1063889483
Provider Name (Legal Business Name): HOPE BRIDGE ADC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2015
Last Update Date: 09/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 STATE ST.
CAYCE SC
29033
US

IV. Provider business mailing address

1111 STATE ST.
CAYCE SC
29033
US

V. Phone/Fax

Practice location:
  • Phone: 803-791-3256
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BARBARA WRIGHT
Title or Position: DIRECTOR
Credential:
Phone: 803-796-5192