Provider Demographics
NPI:1871611889
Name:LAKE CITY ADULT DAY CARE, INC.
Entity type:Organization
Organization Name:LAKE CITY ADULT DAY CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:L
Authorized Official - Last Name:SAULS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-394-8242
Mailing Address - Street 1:122 S ACLINE ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:SC
Mailing Address - Zip Code:29560-2633
Mailing Address - Country:US
Mailing Address - Phone:843-394-8242
Mailing Address - Fax:843-394-1727
Practice Address - Street 1:122 S ACLINE ST
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:SC
Practice Address - Zip Code:29560-2633
Practice Address - Country:US
Practice Address - Phone:843-394-8242
Practice Address - Fax:843-394-1727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility