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General NPI Number Information
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NPI Number | 1720448517
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Entity Type | Organization
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Legal Business Name | MOUNTAIN TOP ADULT DAY CENTER
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Dates
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Enumeration Date | 03/07/2016
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Last Update Date | 03/07/2016
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Provider Practice Location Address
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Address Line | 1941 DECKER BLVD
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City | COLUMBIA
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State | SC
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Zip | 29206-3470
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Country | US
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Telephone | 803-787-0020
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Fax | 803-787-0020
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Provider Business Mailing Address
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Address Line | 1941 DECKER BLVD
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City | COLUMBIA
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State | SC
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Zip | 29206-3470
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Country | US
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Telephone | 803-787-0020
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Fax | 803-787-0020
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | DR. CAROLYN A KENNEDY
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Credential | ED.D.
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Telephone | 803-736-5872
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number | 2016-47738-46733
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License Number State | SC
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