Healthcare Provider Details

I. General information

NPI: 1457121634
Provider Name (Legal Business Name): INNOVATIVE ADULT DAY CENTERS OF THE CAROLINAS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2024
Last Update Date: 01/08/2024
Certification Date: 01/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

368 FORT MILL PARKWAY SUITE 6
FORT MILL SC
29715
US

IV. Provider business mailing address

5183 MILL RACE LN
LANCASTER SC
29720-6926
US

V. Phone/Fax

Practice location:
  • Phone: 803-591-9898
  • Fax: 844-591-0104
Mailing address:
  • Phone: 860-346-0252
  • 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: KELLI P GAGNE
Title or Position: OWNER
Credential: APRN
Phone: 803-591-9898