# CCC OF FAIR PLAY,LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1912216565
- **Authorized official:** JEFFREY SHORE (PRESIDENT)
- **Authorized official phone:** (610) 203-0210

## Contact information

- **Practice address:** 207 FARM HOUSE LN, FAIR PLAY, SC 29643-2207
- **Practice address phone:** (864) 972-1072
- **Mailing address:** 207 FARM HOUSE LN, FAIR PLAY, SC 29643-2207
- **Mailing address phone:** (864) 972-1072

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 310400000X | Assisted Living Facility | CRC1041 | SC | Yes |

## Other

- **Enumeration date:** 09/30/2010
- **Last updated:** 09/30/2010