MEDICARE: ST. MARY'S HOME CARE SERVICES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023356938
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. MARY'S HOME CARE SERVICES, INC.

Provider Business Mailing Address
First Line	:	1977 J N PEASE PL
Second Line	:	SUITE 202
City	:	CHARLOTTE
State	:	NC
Zip	:	28262-4508
Country	:	US
Telephone Number	:	704-335-1900
Fax Number	:

Provider Business Practice Location Address
First Line	:	1977 J N PEASE PL
Second Line	:	SUITE 202
City	:	CHARLOTTE
State	:	NC
Zip	:	28262-4508
Country	:	US
Telephone Number	:	704-335-1900
Fax Number	:	704-335-1888

Authorized Official
Title or Position	:	OWNER
Name	:	ELTON LEE JOSEPH
Credential	:
Telephone Number	:	202-441-2486

Provider Enumeration Date	:	01/28/2013
Last Update Date	:	01/28/2013

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