Provider Demographics
NPI:1174662134
Name:MARLBORO ADULT CARE INC
Entity Type:Organization
Organization Name:MARLBORO ADULT CARE INC
Other - Org Name:MARLBORO ADULT DAY HEALTH CARE INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:P
Authorized Official - Last Name:WASHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:843-479-0603
Mailing Address - Street 1:PO BOX 1484
Mailing Address - Street 2:1039 CHERAW STREET
Mailing Address - City:BENNETTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29512-2422
Mailing Address - Country:US
Mailing Address - Phone:843-479-0603
Mailing Address - Fax:843-479-0081
Practice Address - Street 1:1039 CHERAW STREET
Practice Address - Street 2:
Practice Address - City:BENNETTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29512-2422
Practice Address - Country:US
Practice Address - Phone:843-479-0603
Practice Address - Fax:843-479-0081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCADC 243261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCEX0696Medicaid