=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720287063
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | B&B ASSOCIATES QUALITY CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/17/2007
-----------------------------------------------------
Last Update Date | 07/17/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 535 BUNCE ROAD
-----------------------------------------------------
City | FAYETTEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28314-0000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-978-1385
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 590 CASTLE RISING RD
-----------------------------------------------------
City | FAYETTEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28314-1552
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-867-7518
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/OWNER
-----------------------------------------------------
Name | MR. RICKY ROGER BLAIR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 910-978-1385
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------