Healthcare Provider Details

I. General information

NPI: 1093831976
Provider Name (Legal Business Name): ADMINISTRATIVE CARE SERVICES OF MADISON INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 07/21/2021
Certification Date: 07/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 N SERPENTINE AVE #1
HOT SPRINGS NC
28743
US

IV. Provider business mailing address

PO BOX 41
MARSHALL NC
28753
US

V. Phone/Fax

Practice location:
  • Phone: 828-206-6399
  • Fax: 828-622-9845
Mailing address:
  • Phone: 828-206-6399
  • Fax: 828-622-9845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberFCL-057-007
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: TONYA JOLENE ROBERTS
Title or Position: OFFICE MANAGER
Credential:
Phone: 828-206-6399