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Organization
CCC OF FAIR PLAY,LLC
Active
Organization
CCC OF FAIR PLAY,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY SHORE (PRESIDENT)
(610) 203-0210
Entity
Organization
Contact information
Practice address
207 FARM HOUSE LN, FAIR PLAY, SC 29643-2207
(864) 972-1072
Mailing address
207 FARM HOUSE LN, FAIR PLAY, SC 29643-2207
(864) 972-1072
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
CRC1041
SC
Other
Enumeration date
09/30/2010
Last updated
09/30/2010
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