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General NPI Number Information
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NPI Number | 1548300718
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Entity Type | Organization
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Legal Business Name | ACTIVE SC TWO, INC.
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 05/13/2008
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Provider Practice Location Address
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Address Line | 1118 S MAIN ST
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City | SOCIETY HILL
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State | SC
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Zip | 29593-8989
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Country | US
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Telephone | 843-378-0157
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Fax | 843-378-0158
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Provider Business Mailing Address
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Address Line | 400 REDLAND CT SUITE 114
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City | OWINGS MILLS
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State | MD
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Zip | 21117-3270
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Country | US
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Telephone | 443-548-2200
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Fax | 443-548-2260
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Authorized Official
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Title or Position | CHAIRMAN, CEO, PRESIDENT
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Name | KRIS W. BALDOCK
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Credential |
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Telephone | 443-548-2201
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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