Provider Demographics
NPI:1659307445
Name:SPARTANBURG SENIOR CARE
Entity Type:Organization
Organization Name:SPARTANBURG SENIOR CARE
Other - Org Name:PIEDMONT ADULT DAY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROXIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:AMBURN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-579-7446
Mailing Address - Street 1:2375 E. MAIN ST.
Mailing Address - Street 2:SUITE A-307
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29307-1435
Mailing Address - Country:US
Mailing Address - Phone:864-579-7446
Mailing Address - Fax:864-579-8770
Practice Address - Street 1:2375 E MAIN ST
Practice Address - Street 2:SUITE A-307
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29307-1434
Practice Address - Country:US
Practice Address - Phone:864-579-7446
Practice Address - Fax:864-579-8770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCADC-156261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCEX0514Medicaid