| NPI | 1861708232 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TANYA SHADE Administrator 803-207-7674 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA0600X Clinic/Center Adult Day Care |
| Additional Taxonomies | 103TA0700X Psychologist Adult Development & Aging |
| Enumeration Date | 2010-08-24 |
| Last Update Date | 2010-08-24 |