MEDICARE: ON THE ROAD AGAIN, 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	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1013625458
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ON THE ROAD AGAIN, INC.

Provider Business Mailing Address
First Line	:	804 STAMPER RD STE 101
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28303-4163
Country	:	US
Telephone Number	:	910-323-2875
Fax Number	:

Provider Business Practice Location Address
First Line	:	804 STAMPER RD STE 101
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28303-4163
Country	:	US
Telephone Number	:	910-323-2875
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ALEXANDER MCARTHUR
Credential	:
Telephone Number	:	910-323-2875

Provider Enumeration Date	:	11/14/2022
Last Update Date	:	11/14/2022

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