MEDICARE: CAROL CARE

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	311ZA0620X	Adult Care Home Facility	RN204192	OH

General Provider Information

NPI Number	:	1093006298
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROL CARE

Provider Business Mailing Address
First Line	:	2214 SYCAMORE HILLS DR
Second Line	:
City	:	CENTERVILLE
State	:	OH
Zip	:	45459-1286
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2214 SYCAMORE HILLS DR
Second Line	:
City	:	CENTERVILLE
State	:	OH
Zip	:	45459-1286
Country	:	US
Telephone Number	:	937-938-1326
Fax Number	:

Authorized Official
Title or Position	:	RN
Name	:	CAROL SUE HUGHES
Credential	:
Telephone Number	:	937-938-1326

Provider Enumeration Date	:	04/22/2011
Last Update Date	:	04/22/2011

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