Healthcare Provider Details

I. General information

NPI: 1932256807
Provider Name (Legal Business Name): CONWAY ADULT DAY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 CHURCH ST SUITE 15
CONWAY SC
29526-2929
US

IV. Provider business mailing address

11919 PLAZA DR
MURRELLS INLET SC
29576-9356
US

V. Phone/Fax

Practice location:
  • Phone: 843-369-2273
  • Fax: 843-369-0100
Mailing address:
  • Phone: 843-652-0011
  • Fax: 843-369-0100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberADC165
License Number StateSC

VIII. Authorized Official

Name: MRS. DONNA VALENTINE VANCE II
Title or Position: VICE PRESIDENT OF OPERATIONS
Credential:
Phone: 843-450-3497