MEDICARE: ST. MARY'S HOME CARE SERVICES, 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	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	1041C0700X	Clinical Social Worker

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	:	1184976839
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. MARY'S HOME CARE SERVICES, INC.

Provider Business Mailing Address
First Line	:	PO BOX 16104
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27416-0104
Country	:	US
Telephone Number	:	414-628-0439
Fax Number	:	336-285-5749

Provider Business Practice Location Address
First Line	:	1910 SEDWICK RD
Second Line	:	SUITE 500B
City	:	DURHAM
State	:	NC
Zip	:	27713-7807
Country	:	US
Telephone Number	:	919-363-1462
Fax Number	:	919-367-9474

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ELTON JOSEPH
Credential	:
Telephone Number	:	919-274-7282

Provider Enumeration Date	:	10/04/2012
Last Update Date	:	10/04/2012

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