MEDICARE: CONSOLIDATED CARE 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	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	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

General Provider Information

NPI Number	:	1215933569
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONSOLIDATED CARE INC

Provider Business Mailing Address
First Line	:	PO BOX 817
Second Line	:
City	:	WEST LIBERTY
State	:	OH
Zip	:	43357-0817
Country	:	US
Telephone Number	:	937-465-8065
Fax Number	:	937-465-0442

Provider Business Practice Location Address
First Line	:	1521 N DETROIT ST
Second Line	:
City	:	WEST LIBERTY
State	:	OH
Zip	:	43357-9794
Country	:	US
Telephone Number	:	937-465-8065
Fax Number	:	937-465-0442

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. RANDELL R REMINDER
Credential	:	LPCC
Telephone Number	:	937-465-8065

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	06/17/2008

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