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General NPI Number Information
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NPI Number | 1881825271
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Entity Type | Organization
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Legal Business Name | MORNINGSIDE OF ANDERSON LP
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Dates
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Enumeration Date | 08/03/2009
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Last Update Date | 06/27/2016
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Provider Practice Location Address
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Address Line | 355 BERKMANS LANE
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City | GREENVILLE
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State | SC
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Zip | 29605
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Country | US
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Telephone | 864-467-0031
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Fax |
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Provider Business Mailing Address
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Address Line | 400 CENTRE STREET
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City | NEWTON
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State | MA
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Zip | 02458
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Country | US
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Telephone | 617-796-8160
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Fax | 617-796-8375
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Authorized Official
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Title or Position | PRESIDENT CHIEF EXECUTIVE OFFICER
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Name | BRUCE J MACKEY JR.
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Credential |
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Telephone | 617-796-8214
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311500000X
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Taxonomy Name | Alzheimer Center (Dementia Center)
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License Number | CRC-1244
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 311500000X
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Taxonomy Name | Alzheimer Center (Dementia Center)
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License Number |
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License Number State |
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