MEDICARE: ADMINISTRATIVE CARE SERVICES OF MADISON 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	311ZA0620X	Adult Care Home Facility	FCL-057-007	NC
2	311ZA0620X	Adult Care Home Facility
3	311Z00000X	Custodial Care Facility

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

General Provider Information

NPI Number	:	1093831976
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADMINISTRATIVE CARE SERVICES OF MADISON INC.

Provider Business Mailing Address
First Line	:	PO BOX 41
Second Line	:
City	:	MARSHALL
State	:	NC
Zip	:	28753
Country	:	US
Telephone Number	:	828-206-6399
Fax Number	:	828-622-9845

Provider Business Practice Location Address
First Line	:	311 N SERPENTINE AVE
Second Line	:	#1
City	:	HOT SPRINGS
State	:	NC
Zip	:	28743
Country	:	US
Telephone Number	:	828-206-6399
Fax Number	:	828-622-9845

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	TONYA JOLENE ROBERTS
Credential	:
Telephone Number	:	828-206-6399

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	07/21/2021

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