MEDICARE: BRYANT'S FAMILY HOME 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	251E00000X	Home Health Agency
2	251B00000X	Case Management Agency	HC3907	NC
3	253Z00000X	In Home Supportive Care Agency	HC3907	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	:	1134352990
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRYANT'S FAMILY HOME CARE

Provider Business Mailing Address
First Line	:	110 N PATTERSON ST
Second Line	:
City	:	MAXTON
State	:	NC
Zip	:	28364-1735
Country	:	US
Telephone Number	:	910-844-2500
Fax Number	:	910-844-2504

Provider Business Practice Location Address
First Line	:	110 N PATTERSON ST
Second Line	:
City	:	MAXTON
State	:	NC
Zip	:	28364-1735
Country	:	US
Telephone Number	:	910-844-2500
Fax Number	:	910-844-2500

Authorized Official
Title or Position	:	OWNER
Name	:	MR. RYAN CARNELL BRYANT
Credential	:
Telephone Number	:	910-844-2500

Provider Enumeration Date	:	08/27/2009
Last Update Date	:	01/29/2015

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