Healthcare Provider Details

I. General information

NPI: 1700406998
Provider Name (Legal Business Name): NY'S ADULT DAY CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2020
Last Update Date: 07/30/2025
Certification Date: 04/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 GARDEN AVENUE
GEORGETOWN SC
29440-2925
US

IV. Provider business mailing address

PO BOX 2135
GEORGETOWN SC
29442-2942
US

V. Phone/Fax

Practice location:
  • Phone: 843-461-9010
  • Fax: 843-527-4838
Mailing address:
  • Phone: 843-240-2061
  • Fax: 843-527-4838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MAZIE ELIZABETH GRAHAM
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 843-240-2061