Healthcare Provider Details

I. General information

NPI: 1285317784
Provider Name (Legal Business Name): ADULT DAY ACTIVITIES SAMARITANS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2023
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 S LEWIS ST
PICKENS SC
29671-2521
US

IV. Provider business mailing address

PO BOX 1448
TRAVELERS REST SC
29690-1204
US

V. Phone/Fax

Practice location:
  • Phone: 864-351-8351
  • Fax: 864-689-1200
Mailing address:
  • Phone: 864-842-2327
  • Fax: 864-897-9913

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: MR. LYDELL GRAY
Title or Position: CEO
Credential:
Phone: 864-351-8351