MEDICARE: RECOVERY HEALTHCARE AGENCY

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	:	1538546700
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RECOVERY HEALTHCARE AGENCY

Provider Business Mailing Address
First Line	:	3611 RANBIR DR
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27713-1792
Country	:	US
Telephone Number	:	919-423-5513
Fax Number	:

Provider Business Practice Location Address
First Line	:	1717 S MIAMI BLVD
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27703-5629
Country	:	US
Telephone Number	:	919-423-5513
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MRS. NGOZI REGINA EZE
Credential	:	BSN
Telephone Number	:	919-423-5513

Provider Enumeration Date	:	04/27/2015
Last Update Date	:	04/27/2015

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