=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578296638
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | S.C. (SOUTH CAROLINA) AGING MATTERS CONSULTANCY ,LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/06/2022
-----------------------------------------------------
Last Update Date | 07/06/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 44 PUBLIC SQ STE 100
-----------------------------------------------------
City | DARLINGTON
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29532-3220
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-624-3422
-----------------------------------------------------
Fax | 843-968-8052
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 109 DANIEL ST
-----------------------------------------------------
City | DARLINGTON
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29532-4727
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-624-3422
-----------------------------------------------------
Fax | 843-968-8052
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MRS. DEBRA JACKSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 843-624-3422
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------