MEDICARE: GLOBAL CARE CENTERS, 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	LPC 004963	GA
2	252Y00000X	Early Intervention Provider Agency	LPC 004963	GA
3	251S00000X	Community/Behavioral Health Agency	LPC 004963	GA

General Provider Information

NPI Number	:	1770722563
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLOBAL CARE CENTERS, INC

Provider Business Mailing Address
First Line	:	851 FAYE DR NW
Second Line	:
City	:	KENNESAW
State	:	GA
Zip	:	30144-2113
Country	:	US
Telephone Number	:	770-865-9116
Fax Number	:

Provider Business Practice Location Address
First Line	:	136 HIGHWAY 138 SW
Second Line	:
City	:	RIVERDALE
State	:	GA
Zip	:	30274-4008
Country	:	US
Telephone Number	:	770-865-9116
Fax Number	:

Authorized Official
Title or Position	:	CEO/ADMINISTRATOR
Name	:	DR. TITI AJOKE IPADEOLA
Credential	:	PH.D, LPC
Telephone Number	:	770-865-9116

Provider Enumeration Date	:	02/18/2009
Last Update Date	:	02/18/2009

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