Healthcare Provider Details

I. General information

NPI: 1194849794
Provider Name (Legal Business Name): COMMUNITY ADULT DAY CARE OF MARION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 06/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 EAST JONES AVE EXT
MARION SC
29571
US

IV. Provider business mailing address

PO BOX 491
MARION SC
29571-0491
US

V. Phone/Fax

Practice location:
  • Phone: 843-423-6488
  • Fax:
Mailing address:
  • Phone: 843-423-6488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. DON W. DE NITTO
Title or Position: CEO
Credential:
Phone: 843-423-6488