MEDICARE: EPCA, 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	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center	N/A
2	261Q00000X	Clinic/Center	N/A

General Provider Information

NPI Number	:	1285914150
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EPCA, INC

Provider Business Mailing Address
First Line	:	5207 MASON DIXON AVE
Second Line	:
City	:	BOWLING GREEN
State	:	FL
Zip	:	33834-5095
Country	:	US
Telephone Number	:	863-375-3377
Fax Number	:	863-375-2474

Provider Business Practice Location Address
First Line	:	5207 MASON DIXON AVE
Second Line	:
City	:	BOWLING GREEN
State	:	FL
Zip	:	33834-5095
Country	:	US
Telephone Number	:	863-375-3377
Fax Number	:	863-375-2474

Authorized Official
Title or Position	:	CEO/PRESIDENT
Name	:	MR. JOHNNY PARKER
Credential	:
Telephone Number	:	863-375-3377

Provider Enumeration Date	:	08/24/2011
Last Update Date	:	08/24/2011

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