MEDICARE: HOPE IN THE CAROLINA, L.L.C.

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	322D00000X	Emotionally Disturbed Childrens' Residential Treatment Facility	MHL-082-048	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821172743
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOPE IN THE CAROLINA, L.L.C.

Provider Business Mailing Address
First Line	:	PO BOX 1576
Second Line	:
City	:	ROSEBORO
State	:	NC
Zip	:	28382-1576
Country	:	US
Telephone Number	:	910-916-3929
Fax Number	:	910-296-6246

Provider Business Practice Location Address
First Line	:	206 NORTH EAST STREET
Second Line	:
City	:	ROSEBORO
State	:	NC
Zip	:	28382-5233
Country	:	US
Telephone Number	:	910-916-3929
Fax Number	:	910-296-6246

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. SHELTON JAMES PARKER
Credential	:
Telephone Number	:	910-916-3929

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	07/26/2010

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