=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093006298
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CAROL CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/22/2011
-----------------------------------------------------
Last Update Date | 04/22/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2214 SYCAMORE HILLS DR
-----------------------------------------------------
City | CENTERVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45459-1286
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-938-1326
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2214 SYCAMORE HILLS DR
-----------------------------------------------------
City | CENTERVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45459-1286
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | RN
-----------------------------------------------------
Name | CAROL SUE HUGHES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 937-938-1326
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 311ZA0620X
-----------------------------------------------------
Taxonomy Name | Adult Care Home Facility
-----------------------------------------------------
License Number | RN204192
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------