Provider Demographics
NPI:1497895627
Name:ACTIVE SC TWO, INC.
Entity Type:Organization
Organization Name:ACTIVE SC TWO, INC.
Other - Org Name:RIDGELAND ACTIVE DAY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIRMAN, CEO, PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KRIS
Authorized Official - Middle Name:W
Authorized Official - Last Name:BALDOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-548-2201
Mailing Address - Street 1:400 REDLAND CT
Mailing Address - Street 2:SUITE 114
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-3270
Mailing Address - Country:US
Mailing Address - Phone:443-548-2200
Mailing Address - Fax:443-548-2260
Practice Address - Street 1:8205 E MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:RIDGELAND
Practice Address - State:SC
Practice Address - Zip Code:29936-8576
Practice Address - Country:US
Practice Address - Phone:843-726-6077
Practice Address - Fax:843-726-6074
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ACTIVE DAY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-07
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCEX0426Medicaid