1861453813 NPI number — DARLINGTON PERSONAL SERVICE

Table of content: (NPI 1861453813)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861453813 NPI number — DARLINGTON PERSONAL SERVICE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DARLINGTON PERSONAL SERVICE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LIFELINE OF DARLINGTON
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861453813
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/09/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 29
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DARLINGTON
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29540-0029
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-393-1344
Provider Business Mailing Address Fax Number:
843-398-0691

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
114 FLORIDA DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DARLINGTON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29532-2414
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-393-1344
Provider Business Practice Location Address Fax Number:
843-398-0691
Provider Enumeration Date:
03/29/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BRITT
Authorized Official First Name:
FRANCES
Authorized Official Middle Name:
TINDALL
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
843-393-1344

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: DE1290 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".