Healthcare Provider Details

I. General information

NPI: 1689109845
Provider Name (Legal Business Name): CENTRAL MIDLANDS ADULT DAY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2017
Last Update Date: 04/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 MILLER RD
SUMTER SC
29150-3332
US

IV. Provider business mailing address

500 MILLER RD
SUMTER SC
29150-3332
US

V. Phone/Fax

Practice location:
  • Phone: 803-607-9763
  • Fax:
Mailing address:
  • Phone: 803-607-9763
  • Fax:

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: MRS. CAROLYN WEBB-PRINCE
Title or Position: ADMINISTRATOR
Credential: LPN
Phone: 803-607-9763