ACTIVE SC ONE INC. NPI 1619017027

NPI Information

ACTIVE SC ONE, INC. is an adult day care clinic center in Myrtle Beach, SC. ACTIVE SC ONE, INC. NPI is 1619017027. The provider is registered as an organization entity type.
The provider Is Doing Business As Active Day Of Grand Strand.

The provider's business location address is:

3880 HOUNDSFIELD AVE
MYRTLE BEACH, SC
ZIP 29577-792
Phone: (843) 626-8501
Fax: (843) 916-8858

The provider's authorized official is Debora Hockenbury .
The authorized official title is Contracts Manager and has the following contact phone number (215) 642-6600.

The CLIA number assigned to this NPI record is 42D0981669 - other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/7/2007 and was last updated on 6/30/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

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