Individual
MRS. CHERYL RENEE GIBSON-DALTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PRESIDENT AND CEO
Contact information
Practice address
1231 EUTAW ST, ORANGEBURG, SC 29115-3529
(803) 531-6534
(803) 531-6534
Mailing address
1231 EUTAW ST, ORANGEBURG, SC 29115-3529
(803) 531-6534
(803) 531-6534
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
RC1447
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CRC1447
MEDICAID OSS
SC
Enumeration date
03/22/2015
Last updated
03/22/2015
About Stedi
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