Basic Information
| Provider Information | |||||||||
| NPI: | 1194849794 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMMUNITY ADULT DAY CARE OF MARION, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 491 | ||||||||
| Address2: | |||||||||
| City: | MARION | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295710491 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8434236488 | ||||||||
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| Practice Location | |||||||||
| Address1: | 310 EAST JONES AVE EXT | ||||||||
| Address2: | |||||||||
| City: | MARION | ||||||||
| State: | SC | ||||||||
| PostalCode: | 29571 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8434236488 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/19/2007 | ||||||||
| LastUpdateDate: | 06/03/2009 | ||||||||
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| AuthorizedOfficialLastName: | DE NITTO | ||||||||
| AuthorizedOfficialFirstName: | DON | ||||||||
| AuthorizedOfficialMiddleName: | W. | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8434236488 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA0600X | SC | Y | Ambulatory Health Care Facilities | Clinic/Center | Adult Day Care |
No ID Information.