MEDICARE: COTTAGE HEALTH CARE 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	101YA0400X	Addiction (Substance Use Disorder) Counselor	MHI-092-777	NC
2	101YM0800X	Mental Health Counselor
3	101YP2500X	Professional Counselor
4	101YS0200X	School Counselor
5	103K00000X	Behavior Analyst
6	261QA0600X	Adult Day Care Clinic/Center	MHI-092-777	NC
7	261QD1600X	Developmental Disabilities Clinic/Center	MHI-092-777	NC
8	261QM0850X	Adult Mental Health Clinic/Center	MHI-092-777	NC
9	101Y00000X	Counselor
10	261QM0855X	Adolescent and Children Mental Health Clinic/Center	MHI-092-777	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487975074
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COTTAGE HEALTH CARE SERVICES, INC

Provider Business Mailing Address
First Line	:	3826 BLAND RD
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27609-6239
Country	:	US
Telephone Number	:	919-872-1441
Fax Number	:	919-872-1455

Provider Business Practice Location Address
First Line	:	3826 BLAND RD STE 200
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27609-6239
Country	:	US
Telephone Number	:	919-872-1441
Fax Number	:	919-872-1455

Authorized Official
Title or Position	:	CEO
Name	:	MR. OBIORAH ANACHUNA
Credential	:
Telephone Number	:	919-872-1441

Provider Enumeration Date	:	06/17/2010
Last Update Date	:	11/19/2021

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Directions to “COTTAGE HEALTH CARE SERVICES, INC ” Practice Location

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