Healthcare Provider Details

I. General information

NPI: 1962745679
Provider Name (Legal Business Name): H ALTON BOYD SEINOR CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2013
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

484 NELSON BLVD
KINGSTREE SC
29556-4025
US

IV. Provider business mailing address

484 NELSON BLVD
KINGSTREE SC
29556-4025
US

V. Phone/Fax

Practice location:
  • Phone: 843-355-2420
  • Fax: 843-355-2420
Mailing address:
  • Phone: 843-355-2420
  • Fax: 843-355-2420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number StateSC

VIII. Authorized Official

Name: VICKIE B MITCHELL
Title or Position: ADMINISTRATOR
Credential:
Phone: 843-355-2420