MEDICARE: CENTRACARE CORPORATION

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

General Provider Information

NPI Number	:	1134413545
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRACARE CORPORATION

Provider Business Mailing Address
First Line	:	1703 BLUFFVIEW DR
Second Line	:
City	:	BALCH SPRINGS
State	:	TX
Zip	:	75180-4829
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1703 BLUFFVIEW DR
Second Line	:
City	:	BALCH SPRINGS
State	:	TX
Zip	:	75180-4829
Country	:	US
Telephone Number	:	972-288-1317
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MRS. JENNIFER M UGBEDE
Credential	:
Telephone Number	:	972-288-1317

Provider Enumeration Date	:	06/02/2011
Last Update Date	:	06/02/2011

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Directions to “CENTRACARE CORPORATION ” Practice Location

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