MEDICARE: STANDARD ABOVE ALL, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	174H00000X	Health Educator	NC
2	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility	NC
3	320800000X	Mental Illness Community Based Residential Treatment Facility	NC
4	385H00000X	Respite Care	NC
5	320700000X	Physical Disabilities Residential Treatment Facility	NC

General Provider Information

NPI Number	:	1063788040
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STANDARD ABOVE ALL, INC.

Provider Business Mailing Address
First Line	:	200 BANNER WAY
Second Line	:
City	:	ROCKY MOUNT
State	:	NC
Zip	:	27804-3456
Country	:	US
Telephone Number	:	252-969-1934
Fax Number	:	252-210-9171

Provider Business Practice Location Address
First Line	:	656 HAGGERTY TRL
Second Line	:
City	:	ROCKY MOUNT
State	:	NC
Zip	:	27803-9134
Country	:	US
Telephone Number	:	252-210-3157
Fax Number	:	252-210-9171

Authorized Official
Title or Position	:	OWNER/ADMINISTRATOR
Name	:	MRS. SHANITTA RENEE BROOKS
Credential	:	BSW, QP
Telephone Number	:	252-969-1934

Provider Enumeration Date	:	03/23/2012
Last Update Date	:	03/23/2012

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