Organization Name: | ACTIVE SC TWO, INC. |
NPI Number: | 1548300718 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | KRIS W. BALDOCK (CHAIRMAN, CEO, PRESIDENT) |
Mailing Address: | 1118 S Main St Society Hill |
State: | SC US |
Postal Code: | 295938989 |
Phone Number: | 8433780157 |
Fax Number: | 8433780158 |
NPI Enumeration Date: | 02/07/2007 |
NPI Last Update Date: | 05/13/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QA0600X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Adult Day Care |
Taxonomy Definition: |