Healthcare Provider Details

I. General information

NPI: 1659569895
Provider Name (Legal Business Name): LORIS ADULT DAY CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2007
Last Update Date: 10/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701 MAIN ST
LORIS SC
29569-2901
US

IV. Provider business mailing address

11919 PLAZA DR
MURRELLS INLET SC
29576-9356
US

V. Phone/Fax

Practice location:
  • Phone: 843-716-2425
  • Fax: 843-716-2427
Mailing address:
  • Phone: 843-652-0011
  • Fax: 843-369-0100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberADC-277
License Number StateSC

VIII. Authorized Official

Name: MRS. DONNA VALENTINE VANCE
Title or Position: VICE PRESIDENT
Credential:
Phone: 843-450-3497