MEDICARE: DESHAWNA MARIE CARTER CASE MANAGER/QBS

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

General Provider Information

NPI Number	:	1629688684
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DESHAWNA MARIE CARTER CASE MANAGER/QBS

Provider Business Mailing Address
First Line	:	1105 SCHROCK RD STE 100
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43229-1165
Country	:	US
Telephone Number	:	614-999-1118
Fax Number	:	614-337-1186

Provider Business Practice Location Address
First Line	:	2225 N CASSADY AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43219-1512
Country	:	US
Telephone Number	:	614-999-1118
Fax Number	:	614-337-1186

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/05/2020
Last Update Date	:	07/08/2024

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