Mountain Top Adult Day Center

Primary specialty

Developmentally Disabled Services Day Training AgencyTaxonomy code 251C00000X

License

2016-47738-46733 Issued in SC

Legal business name

MOUNTAIN TOP ADULT DAY CENTER

Doing business as

Mtadc

Practice address

1941 Decker Blvd
Columbia, SC 29206-3470

Phone

(803) 787-0020

Fax

(803) 787-0020

NPI assigned

Mar 7, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Carolyn A Kennedy, ED.D.

Title

Chief Executive Officer

Phone

(803) 736-5872

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• MTADC Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1457308800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1457308800000",
    "number": "1720448517",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1941 DECKER BLVD",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292063470",
            "telephone_number": "803-787-0020",
            "fax_number": "803-787-0020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1941 DECKER BLVD",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292063470",
            "telephone_number": "803-787-0020",
            "fax_number": "803-787-0020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN TOP ADULT DAY CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-07",
        "last_updated": "2016-03-07",
        "status": "A",
        "authorized_official_last_name": "KENNEDY",
        "authorized_official_first_name": "CAROLYN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "803-736-5872",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "ED.D."
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": "SC",
            "license": "2016-47738-46733",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "EX1304",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MTADC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jasmine Monique Moultrie
• Kelly Moultrie
• Stacie Moultrie
• Monique Meshaun Moultry-Watson, LISW-CP
• Niccole Mount, NP
• Gueorgui Iankov Mouratev, M.D.
• Sara Mousavi
• Samantha Marie Mouser, RBT
• Shaka Abdul Moustafa I, PH.D
• John Andrew Mouzakis, M.D.

• Developmentally Disabled Services Day Training Agency in Columbia, SC
• Providers in Columbia, SC by specialty
• Developmentally Disabled Services Day Training Agency in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.