| Organization Name: | COLUMBIA ADULT CARE ON MAIN |
| NPI Number: | 1396076857 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | TAMMY M QUARLES (DIRECTOR) |
| Mailing Address: | 2101 Main St Ste H Columbia |
| State: | SC US |
| Postal Code: | 292012159 |
| Phone Number: | 8032127005 |
| Fax Number: | 8032127005 |
| NPI Enumeration Date: | 01/23/2010 |
| NPI Last Update Date: | 01/23/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 385H00000X |
| License Number: | ADC0292 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | SC |
| Taxonomy Type: | Respite Care Facility |
| Taxonomy Classification: | Respite Care |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |