Healthcare Provider Details

I. General information

NPI: 1992013726
Provider Name (Legal Business Name): CANAAN LAND COMMUNITY DEVELOPMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2010
Last Update Date: 09/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 MCNETT RD
MARION SC
29571-6601
US

IV. Provider business mailing address

1900 MCNETT RD
MARION SC
29571-6601
US

V. Phone/Fax

Practice location:
  • Phone: 843-430-0495
  • Fax:
Mailing address:
  • Phone: 843-430-0495
  • 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: MRS. DESSIE B MCKELVY
Title or Position: EXECUTIVE DIRECTOR
Credential: RNBS
Phone: 843-430-0495