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General NPI Number Information
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NPI Number | 1699638205
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Entity Type | Organization
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Legal Business Name | AMELIA STREET ADULT CARE
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Dates
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Enumeration Date | 12/09/2025
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Last Update Date | 12/09/2025
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Provider Practice Location Address
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Address Line | 1591 AMELIA STREET 1591 AMELIA STREET SUITE #A
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City | ORANGEBURG
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State | SC
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Zip | 29115
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Country | US
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Telephone | 803-747-7606
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Fax | 803-662-9534
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Provider Business Mailing Address
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Address Line | 1591 AMELIA STREET P.O. BOX 363 1591 AMELIA STREET SUITE #A
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City | ORANGEBURG
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State | SC
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Zip | 29115
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Country | US
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Telephone | 803-747-7606
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Fax | 803-662-9534
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Authorized Official
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Title or Position | OWNER/DIRECTOR
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Name | MS. WILLIE DEAN MYERS
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Credential |
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Telephone | 803-937-8155
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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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