MEDICARE: MCCLENDON FUNDERBURK HOME HEALTH CARE, 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	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility		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	:	1346682721
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCCLENDON FUNDERBURK HOME HEALTH CARE, INC.

Provider Business Mailing Address
First Line	:	P.O. BOX 758
Second Line	:
City	:	MINERAL SPRINGS
State	:	NC
Zip	:	28108
Country	:	US
Telephone Number	:	704-843-0793
Fax Number	:

Provider Business Practice Location Address
First Line	:	5218 SPRINGDALE DRIVE
Second Line	:
City	:	WAXHAW
State	:	NC
Zip	:	28713
Country	:	US
Telephone Number	:	704-843-0793
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MRS. LORIETTA MCCLENDON
Credential	:
Telephone Number	:	704-843-0793

Provider Enumeration Date	:	07/25/2013
Last Update Date	:	07/25/2013

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