MEDICARE: EVA LEWIS WASHINGTON ET AL PTR

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	251B00000X	Case Management Agency
2	253Z00000X	In Home Supportive Care Agency	MHL041818	NC
3	251S00000X	Community/Behavioral Health Agency

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	:	1558595892
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVA LEWIS WASHINGTON ET AL PTR

Provider Business Mailing Address
First Line	:	8300 CHARTWELL DR
Second Line	:
City	:	OAK RIDGE
State	:	NC
Zip	:	27310-9814
Country	:	US
Telephone Number	:	336-275-7973
Fax Number	:	336-272-1325

Provider Business Practice Location Address
First Line	:	301 N ELM ST
Second Line	:	SUITE 510
City	:	GREENSBORO
State	:	NC
Zip	:	27401-2083
Country	:	US
Telephone Number	:	336-275-7973
Fax Number	:	336-272-1325

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MRS. EVA LEWIS WASHINGTON
Credential	:	M. ED
Telephone Number	:	336-312-7761

Provider Enumeration Date	:	05/13/2009
Last Update Date	:	03/02/2010

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Directions to “EVA LEWIS WASHINGTON ET AL PTR ” Practice Location

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