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NPI Code Detail

MEDICARE: CAROLINA OUTREACH, LLC

MEDICARE: CAROLINA OUTREACH, LLC
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
1251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1134684392
Entity Type Code : Organization
Provider Name (Legal Business Name) : CAROLINA OUTREACH, LLC
Provider Business Mailing Address
First Line : 2670 DURHAM CHAPEL HILL BLVD
Second Line :
City : DURHAM
State : NC
Zip : 27707-2829
Country : US
Telephone Number : 919-251-9001
Fax Number :
Provider Business Practice Location Address
First Line : 324 PERSON ST
Second Line :
City : FAYETTEVILLE
State : NC
Zip : 28301-5736
Country : US
Telephone Number : 910-438-0939
Fax Number :
Authorized Official
Title or Position : HR MANAGER
Name : ROBERT ANTHONY DAVIS
Credential :
Telephone Number : 919-251-9001
Provider Enumeration Date : 02/01/2019
Last Update Date : 05/20/2019

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Directions to “CAROLINA OUTREACH, LLC ” Practice Location

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