MEDICARE: ULTRA CARE

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	253Z00000X	In Home Supportive Care Agency	036-R-0010	GA

General Provider Information

NPI Number	:	1336478387
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ULTRA CARE

Provider Business Mailing Address
First Line	:	802 E MARTINTOWN RD
Second Line	:	SUITE 157
City	:	NORTH AUGUSTA
State	:	SC
Zip	:	29841-5308
Country	:	US
Telephone Number	:	803-278-0250
Fax Number	:	803-278-0251

Provider Business Practice Location Address
First Line	:	802 E MARTINTOWN RD
Second Line	:	SUITE 157
City	:	NORTH AUGUSTA
State	:	SC
Zip	:	29841-5308
Country	:	US
Telephone Number	:	803-278-0250
Fax Number	:	803-278-0251

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. KATHLEEN CRIST
Credential	:
Telephone Number	:	803-278-0250

Provider Enumeration Date	:	12/21/2009
Last Update Date	:	09/23/2015

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Directions to “ULTRA CARE ” Practice Location

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