MEDICARE: CAROLINA COMPREHENSIVE SERVICES, LLC

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	3747P1801X	Personal Care Attendant
2	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1548405798
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROLINA COMPREHENSIVE SERVICES, LLC

Provider Business Mailing Address
First Line	:	312 W MILLBROOK RD STE 137
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27609-4398
Country	:	US
Telephone Number	:	919-847-0550
Fax Number	:

Provider Business Practice Location Address
First Line	:	312 W MILLBROOK RD STE 137
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27609-4398
Country	:	US
Telephone Number	:	919-847-0550
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. MONDAH TIANGAI PARKINSON
Credential	:
Telephone Number	:	704-507-7674

Provider Enumeration Date	:	12/02/2008
Last Update Date	:	06/16/2010

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