Provider Demographics
NPI:1902094147
Name:CONWAY ADULT DAY CARE AT CREEL ST.
Entity Type:Organization
Organization Name:CONWAY ADULT DAY CARE AT CREEL ST.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:VALENTINE
Authorized Official - Last Name:VANCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-450-3497
Mailing Address - Street 1:11919 PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-9356
Mailing Address - Country:US
Mailing Address - Phone:843-652-0011
Mailing Address - Fax:843-369-0100
Practice Address - Street 1:911 CREEL ST
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29527-5001
Practice Address - Country:US
Practice Address - Phone:843-488-4855
Practice Address - Fax:843-488-4857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-12
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCADC-278261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care