Provider Demographics
NPI:1346835592
Name:LITTLEJOHN COMMUNITY CENTER
Entity Type:Organization
Organization Name:LITTLEJOHN COMMUNITY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ADRAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:GARNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-653-3835
Mailing Address - Street 1:644 OLD GREENVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:CLEMSON
Mailing Address - State:SC
Mailing Address - Zip Code:29631-1225
Mailing Address - Country:US
Mailing Address - Phone:864-653-3835
Mailing Address - Fax:864-653-3852
Practice Address - Street 1:644 OLD GREENVILLE HWY
Practice Address - Street 2:
Practice Address - City:CLEMSON
Practice Address - State:SC
Practice Address - Zip Code:29631-1225
Practice Address - Country:US
Practice Address - Phone:864-653-3835
Practice Address - Fax:864-653-3852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-09
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174200000XOther Service ProvidersMeals