MEDICARE: CCRC HEALTHCARE, 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1679716609
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CCRC HEALTHCARE, INC.

Provider Business Mailing Address
First Line	:	3810 MEDICAL PKWY STE 203
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78756-4014
Country	:	US
Telephone Number	:	512-452-9800
Fax Number	:	512-452-9801

Provider Business Practice Location Address
First Line	:	3810 MEDICAL PKWY STE 203
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78756-4014
Country	:	US
Telephone Number	:	512-452-9800
Fax Number	:	512-452-9801

Authorized Official
Title or Position	:	OWNER, PRESIDENT
Name	:	MR. CHAD MCCALL
Credential	:
Telephone Number	:	512-452-9800

Provider Enumeration Date	:	04/07/2009
Last Update Date	:	04/07/2009

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