MEDICARE: CORPUS CHRISTI 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	251S00000X	Community/Behavioral Health Agency	MHL078147	NC

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	:	1316073760
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORPUS CHRISTI SERVICES, INC.

Provider Business Mailing Address
First Line	:	PO BOX 640
Second Line	:
City	:	PARKTON
State	:	NC
Zip	:	28371-0640
Country	:	US
Telephone Number	:	910-858-1582
Fax Number	:	910-735-2987

Provider Business Practice Location Address
First Line	:	31 ACADIANA DRIVE
Second Line	:
City	:	PARKTON
State	:	NC
Zip	:	28371-9051
Country	:	US
Telephone Number	:	910-858-1582
Fax Number	:	910-735-2987

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. CHERYL RENEE MCRAE
Credential	:
Telephone Number	:	910-858-1582

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	08/22/2020

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