=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235281692
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MAAL-CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/17/2007
-----------------------------------------------------
Last Update Date | 02/19/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1200 OLD FIRETOWER RD
-----------------------------------------------------
City | WINTERVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28590-8447
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-883-8329
-----------------------------------------------------
Fax | 252-756-0052
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2226 OTTER CREEK CHURCH RD
-----------------------------------------------------
City | FOUNTAIN
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27829-9502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-883-8329
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/CEO
-----------------------------------------------------
Name | ADDIE H CARMON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 252-883-8329
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 320600000X
-----------------------------------------------------
Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
-----------------------------------------------------
License Number | MHL 074-159
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------