MEDICARE: MAURICE ROBERTS, JR.

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

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	:	1831254218
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAURICE ROBERTS, JR.

Provider Business Mailing Address
First Line	:	3622 LYCKAN PKWY
Second Line	:	SUITE 6005
City	:	DURHAM
State	:	NC
Zip	:	27707-2564
Country	:	US
Telephone Number	:	919-321-1052
Fax Number	:	919-321-2312

Provider Business Practice Location Address
First Line	:	3622 LYCKAN PKWY
Second Line	:	SUITE 6005
City	:	DURHAM
State	:	NC
Zip	:	27707-2564
Country	:	US
Telephone Number	:	919-321-1052
Fax Number	:	919-321-2312

Authorized Official
Title or Position	:	AGENCY DIRECTOR
Name	:	MS. MONICA GREEN
Credential	:
Telephone Number	:	919-321-1052

Provider Enumeration Date	:	12/26/2006
Last Update Date	:	08/22/2020

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