MEDICARE: THE EMMANUEL HOME III

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

General Provider Information

NPI Number	:	1477977189
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE EMMANUEL HOME III

Provider Business Mailing Address
First Line	:	5212 SWEETBRIAR DR
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27609-4544
Country	:	US
Telephone Number	:	919-607-2041
Fax Number	:	919-890-5571

Provider Business Practice Location Address
First Line	:	405 MORSON ST
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27601-1559
Country	:	US
Telephone Number	:	919-607-2041
Fax Number	:	919-890-5571

Authorized Official
Title or Position	:	MANAGEMENT
Name	:	TAMMY MEADOWS
Credential	:
Telephone Number	:	919-607-2041

Provider Enumeration Date	:	02/17/2014
Last Update Date	:	03/10/2014

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Directions to “THE EMMANUEL HOME III ” Practice Location

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