Provider Demographics
NPI:1457590051
Name:MAGNOLIA ADULT DAY CENTER,LLC
Entity Type:Organization
Organization Name:MAGNOLIA ADULT DAY CENTER,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ASST. ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-934-6036
Mailing Address - Street 1:142 PERKINS AVE
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-6829
Mailing Address - Country:US
Mailing Address - Phone:803-934-6036
Mailing Address - Fax:803-778-1086
Practice Address - Street 1:20 S MAGNOLIA ST
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-5243
Practice Address - Country:US
Practice Address - Phone:803-778-1086
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-05
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCADC-0285261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care