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NPI Code Detail

MEDICARE: BERTINA SCOTT

MEDICARE: BERTINA SCOTT
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
1320800000XMental Illness Community Based Residential Treatment FacilityMHL084107NC
2311ZA0620XAdult Care Home FacilityMHL084107NC

General Provider Information

NPI Number : 1255760245
Entity Type Code : Individual
Provider Name (Legal Business Name) : BERTINA SCOTT
Provider Business Mailing Address
First Line : 403 KNOLLWOOD CIR
Second Line :
City : ALBEMARLE
State : NC
Zip : 28001-9689
Country : US
Telephone Number : 704-984-0553
Fax Number :
Provider Business Practice Location Address
First Line : 43653 COLONIAL HEIGHTS RD
Second Line :
City : NEW LONDON
State : NC
Zip : 28127-9580
Country : US
Telephone Number : 704-422-4080
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/11/2013
Last Update Date : 11/24/2023

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Directions to “ BERTINA SCOTT ” Practice Location

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