MEDICARE: INDIVIDUALIZED CARE 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	251B00000X	Case Management Agency	251B00000X	NC

General Provider Information

NPI Number	:	1629239546
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDIVIDUALIZED CARE INC

Provider Business Mailing Address
First Line	:	543 COX RD
Second Line	:	SUITE E - 4
City	:	GASTONIA
State	:	NC
Zip	:	28054-0607
Country	:	US
Telephone Number	:	704-369-0080
Fax Number	:	704-369-0084

Provider Business Practice Location Address
First Line	:	543 COX RD
Second Line	:	SUITE E - 4
City	:	GASTONIA
State	:	NC
Zip	:	28054-0607
Country	:	US
Telephone Number	:	704-369-0080
Fax Number	:	704-369-0084

Authorized Official
Title or Position	:	CFO
Name	:	MS. DJARRIS Y HARRIS
Credential	:
Telephone Number	:	704-369-0080

Provider Enumeration Date	:	06/23/2008
Last Update Date	:	06/30/2008

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