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General NPI Number Information
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NPI Number | 1295286573
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Entity Type | Organization
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Legal Business Name | S&S BOARDING HOME,LLC
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Dates
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Enumeration Date | 10/20/2016
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Last Update Date | 10/20/2016
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Provider Practice Location Address
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Address Line | 3589 BLUFF RD
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City | ALLENDALE
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State | SC
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Zip | 29810-4139
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Country | US
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Telephone | 803-686-1487
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Fax | 803-584-2518
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Provider Business Mailing Address
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Address Line | PO BOX 324
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City | ALLENDALE
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State | SC
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Zip | 29810-0324
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. ELAINE E SABB
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Credential |
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Telephone | 803-686-1487
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number | CRC-1923
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License Number State | SC
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