MEDICARE: SPECIAL K. ENRICHMENT, 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	302R00000X	Health Maintenance Organization		NC
2	3747P1801X	Personal Care Attendant

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932256021
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPECIAL K. ENRICHMENT, INC.

Provider Business Mailing Address
First Line	:	PO BOX 668882
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28266
Country	:	US
Telephone Number	:	704-395-9387
Fax Number	:	704-395-9436

Provider Business Practice Location Address
First Line	:	2838 A QUEEN CITY DRIVE
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28208-2738
Country	:	US
Telephone Number	:	704-395-9387
Fax Number	:	704-395-9436

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	SHARON A. KENDRICK
Credential	:
Telephone Number	:	704-395-9387

Provider Enumeration Date	:	01/04/2007
Last Update Date	:	12/16/2010

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Directions to “SPECIAL K. ENRICHMENT, INC. ” Practice Location

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