Provider Demographics
NPI:1457121634
Name:INNOVATIVE ADULT DAY CENTERS OF THE CAROLINAS INC
Entity Type:Organization
Organization Name:INNOVATIVE ADULT DAY CENTERS OF THE CAROLINAS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:P
Authorized Official - Last Name:GAGNE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:803-591-9898
Mailing Address - Street 1:5183 MILL RACE LN
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:SC
Mailing Address - Zip Code:29720-6926
Mailing Address - Country:US
Mailing Address - Phone:860-346-0252
Mailing Address - Fax:
Practice Address - Street 1:368 FORT MILL PARKWAY
Practice Address - Street 2:SUITE 6
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29715
Practice Address - Country:US
Practice Address - Phone:803-591-9898
Practice Address - Fax:844-591-0104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care