MEDICARE: OPTIONS TO DOMESTIC VIOLENCE & SEXUAL ASSAULT 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	385H00000X	Respite Care

General Provider Information

NPI Number	:	1659533784
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTIONS TO DOMESTIC VIOLENCE & SEXUAL ASSAULT INC.

Provider Business Mailing Address
First Line	:	PO BOX 1387
Second Line	:
City	:	WASHINGTON
State	:	NC
Zip	:	27889-1387
Country	:	US
Telephone Number	:	252-946-3219
Fax Number	:	252-948-1477

Provider Business Practice Location Address
First Line	:	804 N MARKET ST
Second Line	:
City	:	WASHINGTON
State	:	NC
Zip	:	27889-4452
Country	:	US
Telephone Number	:	252-946-3219
Fax Number	:	252-948-1477

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. LEE ANNE HANSON
Credential	:	CCFC
Telephone Number	:	252-946-3219

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

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