MEDICARE: HOUSE OF CARE, 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	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	MHL-051-189	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063854503
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOUSE OF CARE, INC

Provider Business Mailing Address
First Line	:	3500 WESTGATE DR
Second Line	:	SUITE 501
City	:	DURHAM
State	:	NC
Zip	:	27707-2567
Country	:	US
Telephone Number	:	919-493-6871
Fax Number	:	919-493-6878

Provider Business Practice Location Address
First Line	:	109 DEER FARM LN
Second Line	:
City	:	WILLOW SPRING
State	:	NC
Zip	:	27592-8505
Country	:	US
Telephone Number	:	919-493-6871
Fax Number	:	919-493-6878

Authorized Official
Title or Position	:	DIRECTOR
Name	:	OGO EMODI-ONWUKA
Credential	:	BA
Telephone Number	:	919-493-6871

Provider Enumeration Date	:	07/25/2013
Last Update Date	:	07/25/2013

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Directions to “HOUSE OF CARE, INC ” Practice Location

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