Healthcare Provider Details

I. General information

NPI: 1952435430
Provider Name (Legal Business Name): MORNINGSIDE OF ANDERSON, LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 06/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 SUMMIT TERRACE
COLUMBIA SC
29229
US

IV. Provider business mailing address

400 CENTRE STREET
NEWTON MA
02458
US

V. Phone/Fax

Practice location:
  • Phone: 803-788-4633
  • Fax: 803-461-5808
Mailing address:
  • Phone: 617-796-8160
  • Fax: 617-796-8375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License NumberCRC-1240
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number
License Number State

VIII. Authorized Official

Name: BRUCE J MACKEY JR.
Title or Position: PRESIDENT & CHIEF EXECUTIVE OFFICER
Credential:
Phone: 617-796-8214