MEDICARE: UNLIMITED POSSIBILITIES FAMILY HOME CARE

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	311ZA0620X	Adult Care Home Facility	FCL000100	NC

General Provider Information

NPI Number	:	1619202710
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNLIMITED POSSIBILITIES FAMILY HOME CARE

Provider Business Mailing Address
First Line	:	5226 ADDISON DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28211-4135
Country	:	US
Telephone Number	:	704-453-6753
Fax Number	:	704-749-9522

Provider Business Practice Location Address
First Line	:	5003 TEWKESBURY RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28269-4557
Country	:	US
Telephone Number	:	704-453-6753
Fax Number	:	704-749-9522

Authorized Official
Title or Position	:	OWNER/ADMINISTRATOR
Name	:	MR. JAMES HENRY SCRUGGS JR.
Credential	:
Telephone Number	:	704-453-6753

Provider Enumeration Date	:	10/07/2009
Last Update Date	:	10/07/2009

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