MEDICARE: BAITUL HEMAYAH, 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

General Provider Information

NPI Number	:	1295210409
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAITUL HEMAYAH, INC.

Provider Business Mailing Address
First Line	:	4301 SHAMROCK DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28215-3915
Country	:	US
Telephone Number	:	704-247-3790
Fax Number	:

Provider Business Practice Location Address
First Line	:	4301 SHAMROCK DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28215-3915
Country	:	US
Telephone Number	:	704-247-3790
Fax Number	:

Authorized Official
Title or Position	:	DOMESTIC VIOLENCE SPECIALIST
Name	:	SAIDAH SUDAN
Credential	:	DVS
Telephone Number	:	704-247-3790

Provider Enumeration Date	:	10/03/2018
Last Update Date	:	10/03/2018

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