MEDICARE: SCARE, 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	251B00000X	Case Management Agency	3157717	NC

General Provider Information

NPI Number	:	1184813628
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SCARE, INC.

Provider Business Mailing Address
First Line	:	688 HANNER TOWN RD
Second Line	:
City	:	BEAR CREEK
State	:	NC
Zip	:	27207-9255
Country	:	US
Telephone Number	:	919-837-2438
Fax Number	:

Provider Business Practice Location Address
First Line	:	688 HANNER TOWN RD
Second Line	:
City	:	BEAR CREEK
State	:	NC
Zip	:	27207-9255
Country	:	US
Telephone Number	:	919-837-2438
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CLYDE OCTAVIS HARRIS
Credential	:	EDD
Telephone Number	:	919-837-2438

Provider Enumeration Date	:	10/22/2007
Last Update Date	:	10/22/2007

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