MEDICARE: COMMUNITY ALTERNATIVE HOUSING 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	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720272826
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY ALTERNATIVE HOUSING INC

Provider Business Mailing Address
First Line	:	PO BOX 87195
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28304-7195
Country	:	US
Telephone Number	:	910-486-8989
Fax Number	:	910-826-3695

Provider Business Practice Location Address
First Line	:	2905 BREEZEWOOD AVE
Second Line	:	SUITE 104
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28303-5503
Country	:	US
Telephone Number	:	910-486-8989
Fax Number	:	910-826-3695

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. WILBERT NICHOLS III
Credential	:	LPCA
Telephone Number	:	910-486-8989

Provider Enumeration Date	:	08/31/2007
Last Update Date	:	04/10/2014

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