Provider Demographics
NPI:1912164971
Name:TRIPLE E RESIDENTIAL CARE
Entity Type:Organization
Organization Name:TRIPLE E RESIDENTIAL CARE
Other - Org Name:TRIPLE E ADULT DAY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ARETHA
Authorized Official - Middle Name:FRANKLIN
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-671-2044
Mailing Address - Street 1:PO BOX 1026
Mailing Address - Street 2:
Mailing Address - City:ALLENDALE
Mailing Address - State:SC
Mailing Address - Zip Code:29810-1026
Mailing Address - Country:US
Mailing Address - Phone:803-671-2044
Mailing Address - Fax:803-584-7003
Practice Address - Street 1:286 WATER ST
Practice Address - Street 2:
Practice Address - City:ALLENDALE
Practice Address - State:SC
Practice Address - Zip Code:29810-3512
Practice Address - Country:US
Practice Address - Phone:803-671-2044
Practice Address - Fax:803-584-7003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-19
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCEXG042251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services