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General NPI Number Information
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NPI Number | 1669784526
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Entity Type | Organization
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Legal Business Name | GENCASCO INC
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Dates
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Enumeration Date | 07/08/2010
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Last Update Date | 07/08/2010
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Provider Practice Location Address
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Address Line | 2779 HIGHWAY 15 N
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City | BISHOPVILLE
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State | SC
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Zip | 29010-7101
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Country | US
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Telephone | 803-428-2222
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Fax | 803-428-2333
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Provider Business Mailing Address
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Address Line | 2779 HIGHWAY 15 N
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City | BISHOPVILLE
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State | SC
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Zip | 29010-7101
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Country | US
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Telephone | 803-428-2222
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Fax | 803-428-2333
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Authorized Official
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Title or Position | ADMINISTRATION
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Name | MRS. CASSIE TIMMONS JONES
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Credential |
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Telephone | 803-428-2222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | RC1108
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License Number State | SC
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