MEDICARE: ASD-PCS-DURHAM

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	251E00000X	Home Health Agency	HC1308	NC

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

General Provider Information

NPI Number	:	1174795165
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASD-PCS-DURHAM

Provider Business Mailing Address
First Line	:	8430 UNIVERSITY EXEC PARK DR
Second Line	:	SUITE 655
City	:	CHARLOTTE
State	:	NC
Zip	:	28262-1350
Country	:	US
Telephone Number	:	704-549-1659
Fax Number	:	704-549-1664

Provider Business Practice Location Address
First Line	:	3600 N DUKE ST
Second Line	:	SUITE 103
City	:	DURHAM
State	:	NC
Zip	:	27704-1709
Country	:	US
Telephone Number	:	919-471-1800
Fax Number	:	919-471-1877

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MRS. VERONICA K. MCLENDON
Credential	:
Telephone Number	:	704-549-1659

Provider Enumeration Date	:	03/31/2008
Last Update Date	:	03/31/2008

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Directions to “ASD-PCS-DURHAM ” Practice Location

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