CCC of Fair Play,LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

CRC1041 Issued in SC

Legal business name

CCC OF FAIR PLAY,LLC

Practice address

207 Farm House LN
Fair Play, SC 29643-2207

Phone

(864) 972-1072

NPI assigned

Sep 30, 2010

Last updated

Sep 30, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jeffrey Shore

Title

President

Phone

(610) 203-0210

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1285804800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1285804800000",
    "number": "1912216565",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "207 FARM HOUSE LN",
            "city": "FAIR PLAY",
            "state": "SC",
            "postal_code": "296432207",
            "telephone_number": "864-972-1072"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207 FARM HOUSE LN",
            "city": "FAIR PLAY",
            "state": "SC",
            "postal_code": "296432207",
            "telephone_number": "864-972-1072"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CCC OF FAIR PLAY,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-30",
        "last_updated": "2010-09-30",
        "status": "A",
        "authorized_official_last_name": "SHORE",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "610-203-0210"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "SC",
            "license": "CRC1041",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anmed Health (AnMed Health Fairplay Family Medicine)
• Carolina Speech Services, Inc.
• Country Christian Care Inc
• Mays Clinic
• Mays Clinic Pharmacy
• Wilderness Way Camp School Inc
• Woodlandway Family Practice

• Assisted Living Facility in Fair Play, SC
• Providers in Fair Play, SC by specialty
• Assisted Living Facility in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2010; 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.