Healthcare Provider Details

I. General information

NPI: 1346875572
Provider Name (Legal Business Name): MOTHER DEVEAUX ADULT DAY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2020
Last Update Date: 03/09/2020
Certification Date: 03/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

528 MAIN ST
EASTOVER SC
29044-9701
US

IV. Provider business mailing address

528 MAIN ST
EASTOVER SC
29044-9701
US

V. Phone/Fax

Practice location:
  • Phone: 803-353-8475
  • Fax:
Mailing address:
  • Phone: 803-353-8475
  • 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: MRS. SARA DEVEAUX
Title or Position: PRESIDENT
Credential:
Phone: 803-353-8475