Provider Demographics
NPI:1952528804
Name:TRIPLE E RESIDENTIAL CARE
Entity Type:Organization
Organization Name:TRIPLE E RESIDENTIAL CARE
Other - Org Name:TRIPLE E ADULT DAY CARE #1
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER ADMINISTRATOR
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:803-541-9124
Mailing Address - Street 1:140 APPLE ST
Mailing Address - Street 2:P O BOX 1216
Mailing Address - City:BARNWELL
Mailing Address - State:SC
Mailing Address - Zip Code:29812-3022
Mailing Address - Country:US
Mailing Address - Phone:803-541-9124
Mailing Address - Fax:803-584-7003
Practice Address - Street 1:140 APPLE ST
Practice Address - Street 2:
Practice Address - City:BARNWELL
Practice Address - State:SC
Practice Address - Zip Code:29812-3022
Practice Address - Country:US
Practice Address - Phone:803-541-9124
Practice Address - Fax:803-584-7003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCADC148251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services