Healthcare Provider Details

I. General information

NPI: 1497145577
Provider Name (Legal Business Name): UPTOWN SENIOR, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2015
Last Update Date: 02/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 MAIN ST S
GREENWOOD SC
29646-3245
US

IV. Provider business mailing address

615 MAIN ST S
GREENWOOD SC
29646-3245
US

V. Phone/Fax

Practice location:
  • Phone: 864-377-8042
  • Fax: 864-377-8043
Mailing address:
  • Phone: 864-377-8042
  • Fax: 864-377-8043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberADC-0307
License Number StateSC

VIII. Authorized Official

Name: MRS. AMY STRIBLING MARS
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 864-377-8042