MEDICARE: ETCARE HOME QUALITY MANAGEMENT, 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	310400000X	Assisted Living Facility	HAL-024-009	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	:	1609996446
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ETCARE HOME QUALITY MANAGEMENT, INC

Provider Business Mailing Address
First Line	:	PO BOX 1179
Second Line	:
City	:	PEMBROKE
State	:	NC
Zip	:	28372-1179
Country	:	US
Telephone Number	:	910-521-5550
Fax Number	:	910-521-3335

Provider Business Practice Location Address
First Line	:	206 WANNISH AVE
Second Line	:
City	:	LAKE WACCAMAW
State	:	NC
Zip	:	28450
Country	:	US
Telephone Number	:	910-646-3153
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	EDITH W. BIGLER
Credential	:
Telephone Number	:	910-521-5550

Provider Enumeration Date	:	03/29/2007
Last Update Date	:	06/13/2008

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