Provider Demographics
NPI:1619201902
Name:MOMMA & POPPA COMMUNITY RESIDENTIAL CARE FACILITY
Entity Type:Organization
Organization Name:MOMMA & POPPA COMMUNITY RESIDENTIAL CARE FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ CEO
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:G
Authorized Official - Last Name:STEELE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-833-3473
Mailing Address - Street 1:719 SHEARWATER CT
Mailing Address - Street 2:UNIT 202
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-8686
Mailing Address - Country:US
Mailing Address - Phone:843-833-3473
Mailing Address - Fax:
Practice Address - Street 1:534 MARTIN LUTHER KING RD
Practice Address - Street 2:
Practice Address - City:PAWLEYS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29585-6001
Practice Address - Country:US
Practice Address - Phone:843-833-3473
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-20
Last Update Date:2009-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility