| Organization Name: | STEPHENS ACTIVE ADULT DAY CARE |
| NPI Number: | 1164813267 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BARBARA STEPHEN (EXECUTIVE DIRECTOR) |
| Mailing Address: | 3501 Highway 917 Loris |
| State: | SC US |
| Postal Code: | 295699041 |
| Phone Number: | 8432837815 |
| Fax Number: | |
| NPI Enumeration Date: | 02/10/2015 |
| NPI Last Update Date: | 02/10/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP1600X |
| License Number: | 1558769695 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | SC |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Pastoral |
| Taxonomy Definition: | |