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General NPI Number Information
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NPI Number | 1992013726
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Entity Type | Organization
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Legal Business Name | CANAAN LAND COMMUNITY DEVELOPMENT CENTER
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Dates
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Enumeration Date | 09/14/2010
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Last Update Date | 09/14/2010
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Provider Practice Location Address
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Address Line | 1900 MCNETT RD
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City | MARION
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State | SC
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Zip | 29571-6601
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Country | US
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Telephone | 843-430-0495
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Fax |
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Provider Business Mailing Address
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Address Line | 1900 MCNETT RD
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City | MARION
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State | SC
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Zip | 29571-6601
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Country | US
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Telephone | 843-430-0495
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. DESSIE B MCKELVY
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Credential | RNBS
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Telephone | 843-430-0495
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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 | SC
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