Healthcare Provider Details

I. General information

NPI: 1962970012
Provider Name (Legal Business Name): DAILY LIVING ADC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2018
Last Update Date: 04/17/2020
Certification Date: 04/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1307 N LONGSTREET ST
KINGSTREE SC
29556-2739
US

IV. Provider business mailing address

1307 N LONGSTREET ST
KINGSTREE SC
29556-2739
US

V. Phone/Fax

Practice location:
  • Phone: 843-206-9042
  • Fax:
Mailing address:
  • Phone: 843-206-9042
  • 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: LAVONYA WILLIAMS
Title or Position: OWNER
Credential:
Phone: 843-206-9042