Basic Information
| Provider Information | |||||||||
| NPI: | 1669776134 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NEW GENERATIONS ADULT DAY CENTER OF FLORENCE INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | COMMUNITY ADULT DAY CENTER OF MARION | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 EAST JONES STREET EXTENSION | ||||||||
| Address2: | |||||||||
| City: | MARION | ||||||||
| State: | SC | ||||||||
| PostalCode: | 29571 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8434236488 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2111 W. JODY ROAD | ||||||||
| Address2: | |||||||||
| City: | FLORENCE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 29501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8436290103 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/27/2010 | ||||||||
| LastUpdateDate: | 12/27/2010 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | BELISSARY | ||||||||
| AuthorizedOfficialFirstName: | GAIL | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 8436290103 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | NEW GENERATIONS ADULT DAY CENTER OF FLORENCE INC | ||||||||
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| AuthorizedOfficialCredential: | RN BSN | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 311ZA0620X | Y | Nursing & Custodial Care Facilities | Custodial Care Facility | Adult Care Home |
ID Information
| ID | Type | State | Issuer | Description | EN1074 | 05 | SC | MEDICAID |