MEDICARE: T ROBINSON FAMILY FIRST LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251B00000X	Case Management Agency
2	3104A0625X	Assisted Living Facility (Mental Illness)
3	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1386197747
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	T ROBINSON FAMILY FIRST LLC

Provider Business Mailing Address
First Line	:	7000 REGENT PKWY
Second Line	:	SUITE 101
City	:	FORT MILL
State	:	SC
Zip	:	29715-8424
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7000 REGENT PKWY
Second Line	:	SUITE 101
City	:	FORT MILL
State	:	SC
Zip	:	29715-8424
Country	:	US
Telephone Number	:	704-614-2275
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DARLENE TATE
Credential	:
Telephone Number	:	704-614-2275

Provider Enumeration Date	:	08/02/2016
Last Update Date	:	08/02/2016

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