MEDICARE: CARTER'S CIRCLE OF 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	322D00000X	Emotionally Disturbed Childrens' Residential Treatment Facility	MHL0411052	NC

General Provider Information

NPI Number	:	1508106394
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARTER'S CIRCLE OF CARE, INC

Provider Business Mailing Address
First Line	:	4137 KEELY RD
Second Line	:
City	:	MC LEANSVILLE
State	:	NC
Zip	:	27301-9746
Country	:	US
Telephone Number	:	336-375-2150
Fax Number	:

Provider Business Practice Location Address
First Line	:	2031 MARTIN LUTHER KING JR DR
Second Line	:	SUITE E
City	:	GREENSBORO
State	:	NC
Zip	:	27406-3342
Country	:	US
Telephone Number	:	336-271-5888
Fax Number	:

Authorized Official
Title or Position	:	VP/DIRECTOR OF OPERATIONS
Name	:	MR. RONALD EUGENE CARTER JR.
Credential	:
Telephone Number	:	336-375-2150

Provider Enumeration Date	:	02/15/2013
Last Update Date	:	02/15/2013

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