MEDICARE: CAROLINA FAMILY COMPREHENSIVE SERVICES, INC.

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1013211242
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROLINA FAMILY COMPREHENSIVE SERVICES, INC.

Provider Business Mailing Address
First Line	:	1935 JN PEASE PL STE 104
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28262-4541
Country	:	US
Telephone Number	:	704-548-9600
Fax Number	:	704-548-9666

Provider Business Practice Location Address
First Line	:	1935 JN PEASE PL STE 104
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28262-4541
Country	:	US
Telephone Number	:	704-548-9600
Fax Number	:	704-548-9666

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. KIM R. CRUMP
Credential	:	MED
Telephone Number	:	704-548-9600

Provider Enumeration Date	:	01/03/2011
Last Update Date	:	01/03/2011

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