Healthcare Provider Details

I. General information

NPI: 1326371196
Provider Name (Legal Business Name): D.A.V.& ELDERLY ASSISTANTS FOR LIFE,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2009
Last Update Date: 12/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

781 CHERRY HILL RD
RIDGELAND SC
29936-7653
US

IV. Provider business mailing address

PO BOX 864
RIDGELAND SC
29936-2615
US

V. Phone/Fax

Practice location:
  • Phone: 843-473-2068
  • Fax:
Mailing address:
  • Phone: 843-473-2068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number2374
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number2374
License Number StateSC

VIII. Authorized Official

Name: MRS. CYNTHIA WHITE
Title or Position: CEO
Credential:
Phone: 843-473-2068