MEDICARE: UNITED COUNTRY 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	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility	AL380007070	MI

General Provider Information

NPI Number	:	1356661201
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNITED COUNTRY CARE INC.

Provider Business Mailing Address
First Line	:	PO BOX 84
Second Line	:
City	:	PARMA
State	:	MI
Zip	:	49269-0084
Country	:	US
Telephone Number	:	517-531-3005
Fax Number	:	517-531-5775

Provider Business Practice Location Address
First Line	:	356 S UNION ST
Second Line	:
City	:	PARMA
State	:	MI
Zip	:	49269-9418
Country	:	US
Telephone Number	:	517-531-3005
Fax Number	:	517-531-5775

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LINDA RICE
Credential	:
Telephone Number	:	517-531-3005

Provider Enumeration Date	:	06/02/2010
Last Update Date	:	06/02/2010

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Directions to “UNITED COUNTRY CARE INC. ” Practice Location

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