Provider Demographics
NPI:1467004705
Name:GOOD SAMARITAN ADULT DAY CARE
Entity Type:Organization
Organization Name:GOOD SAMARITAN ADULT DAY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:PENDERGRASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-382-2966
Mailing Address - Street 1:473 KINDALE PARK RD
Mailing Address - Street 2:
Mailing Address - City:KINGSTREE
Mailing Address - State:SC
Mailing Address - Zip Code:29556-5182
Mailing Address - Country:US
Mailing Address - Phone:843-382-2966
Mailing Address - Fax:843-382-2298
Practice Address - Street 1:473 KINDALE PARK RD
Practice Address - Street 2:
Practice Address - City:KINGSTREE
Practice Address - State:SC
Practice Address - Zip Code:29556-5182
Practice Address - Country:US
Practice Address - Phone:843-382-2966
Practice Address - Fax:843-382-2298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-16
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care