Provider Demographics
NPI:1093962359
Name:EDGEFIELD COUNTY SENIOR CITIZENS COUNCIL
Entity Type:Organization
Organization Name:EDGEFIELD COUNTY SENIOR CITIZENS COUNCIL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:GRIFFITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-637-5326
Mailing Address - Street 1:15 CENTER SPRINGS ROAD
Mailing Address - Street 2:
Mailing Address - City:EDGEFIELD
Mailing Address - State:SC
Mailing Address - Zip Code:29824
Mailing Address - Country:US
Mailing Address - Phone:803-637-5326
Mailing Address - Fax:803-637-4015
Practice Address - Street 1:15 CENTER SPRING ROAD
Practice Address - Street 2:
Practice Address - City:EDGEFIELD
Practice Address - State:SC
Practice Address - Zip Code:29824
Practice Address - Country:US
Practice Address - Phone:803-637-5326
Practice Address - Fax:803-637-4015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-19
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCADC0006251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCEX0081Medicaid