MEDICARE: ADULT CARE OF THE CAROLINAS 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	310400000X	Assisted Living Facility	CRC-0384	SC

General Provider Information

NPI Number	:	1093030777
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADULT CARE OF THE CAROLINAS INC

Provider Business Mailing Address
First Line	:	936 7TH ST
Second Line	:	SUITE B #129
City	:	NOVATO
State	:	CA
Zip	:	94945-3010
Country	:	US
Telephone Number	:	480-444-9956
Fax Number	:	480-323-2371

Provider Business Practice Location Address
First Line	:	2860 NEW CUT RD
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29303-6332
Country	:	US
Telephone Number	:	864-439-7347
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. GARY JACOBS
Credential	:
Telephone Number	:	480-444-9956

Provider Enumeration Date	:	04/06/2010
Last Update Date	:	04/06/2010

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