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General NPI Number Information
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NPI Number | 1508152364
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Entity Type | Organization
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Legal Business Name | DILLON ADULT DAY CARE LLC
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Dates
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Enumeration Date | 06/21/2011
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Last Update Date | 06/22/2022
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Provider Practice Location Address
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Address Line | 106 W WASHINGTON ST
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City | DILLON
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State | SC
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Zip | 29536-2850
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Country | US
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Telephone | 843-487-5040
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Fax | 843-487-5041
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Provider Business Mailing Address
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Address Line | PO BOX 253
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City | LITTLE ROCK
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State | SC
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Zip | 29567-0253
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Country | US
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Telephone | 843-487-5043
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Fax | 843-841-0942
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | MARY LOUISE JOHNS
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Credential |
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Telephone | 843-453-1435
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | EX0680
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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