MEDICARE: ASPIRATIONS AND MIRACLES COMMUNITY SUPPORT LLC

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

General Provider Information

NPI Number	:	1861785222
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASPIRATIONS AND MIRACLES COMMUNITY SUPPORT LLC

Provider Business Mailing Address
First Line	:	5421 OLD POOLE RD
Second Line	:	SUITE 107
City	:	RALEIGH
State	:	NC
Zip	:	27610-3285
Country	:	US
Telephone Number	:	919-673-2146
Fax Number	:

Provider Business Practice Location Address
First Line	:	5421 OLD POOLE RD
Second Line	:	SUITE 107
City	:	RALEIGH
State	:	NC
Zip	:	27610-3285
Country	:	US
Telephone Number	:	919-673-2146
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	CAROLYN WESTERN
Credential	:
Telephone Number	:	252-442-0011

Provider Enumeration Date	:	05/18/2011
Last Update Date	:	05/18/2011

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