=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659307445
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SPARTANBURG SENIOR CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/23/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2375 E MAIN ST SUITE A-307
-----------------------------------------------------
City | SPARTANBURG
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29307-1434
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-579-7446
-----------------------------------------------------
Fax | 864-579-8770
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2375 E. MAIN ST. SUITE A-307
-----------------------------------------------------
City | SPARTANBURG
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29307-1435
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-579-7446
-----------------------------------------------------
Fax | 864-579-8770
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ASSISTANT DIRECTOR
-----------------------------------------------------
Name | ROXIE J AMBURN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 864-579-7446
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA0600X
-----------------------------------------------------
Taxonomy Name | Adult Day Care Clinic/Center
-----------------------------------------------------
License Number | ADC-156
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------