MEDICARE: SURECARE HOMECARE

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	:	1972229631
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SURECARE HOMECARE

Provider Business Mailing Address
First Line	:	819 W RALEIGH BLVD
Second Line	:
City	:	ROCKY MOUNT
State	:	NC
Zip	:	27803-2764
Country	:	US
Telephone Number	:	919-879-3132
Fax Number	:	919-585-7377

Provider Business Practice Location Address
First Line	:	819 W RALEIGH BLVD
Second Line	:
City	:	ROCKY MOUNT
State	:	NC
Zip	:	27803-2764
Country	:	US
Telephone Number	:	908-249-1334
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ZENOBIA SMITH BRACK
Credential	:	RN
Telephone Number	:	908-249-1334

Provider Enumeration Date	:	10/14/2022
Last Update Date	:	10/14/2022

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