Miranda Willis Adult Day Care, LLC

Primary specialty

Adult Day Care Clinic/CenterTaxonomy code 261QA0600X

Legal business name

MIRANDA WILLIS ADULT DAY CARE, LLC

Practice address

5932 McMillian Circle
Columbia, SC 29212

Phone

(803) 586-7455

NPI assigned

Aug 12, 2014

Organization subpart

No

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

Authorized official

Name

Ms. Crystal M Willis, LBSW, SW-G, CDP

Title

Ceo

Phone

(803) 586-7455

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1407801600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1408060800000",
    "number": "1902215296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5932 MCMILLIAN CIRCLE",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "29212",
            "telephone_number": "803-586-7455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5932 MCMILLIAN CIRCLE",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "29212",
            "telephone_number": "803-586-7455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIRANDA WILLIS ADULT DAY CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-12",
        "last_updated": "2014-08-15",
        "status": "A",
        "authorized_official_last_name": "WILLIS",
        "authorized_official_first_name": "CRYSTAL",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "803-586-7455",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LBSW, SW-G, CDP"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker",
            "state": "SC",
            "license": "10532",
            "primary": false
        },
        {
            "code": "261QA0600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Day Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Demerise Ott Minor, FNP
• Tomas Minor, PH.D.
• Meaghan Minori
• Jamie Minter, LISW-CP
• Steven Minter, D.O.
• Elizabeth Harvey Miranda-Needham, LMSW
• Juan Miranda
• Sharon Y Mirante, A.P.N
• Martin C Mirra, MD
• Sydney Misencik

• Adult Day Care Clinic/Center in Columbia, SC
• Providers in Columbia, SC by specialty
• Adult Day Care Clinic/Center in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2014; 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.