MEDICARE: CARLIN SUPPORT COORDINATION, LLC

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1962848762
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARLIN SUPPORT COORDINATION, LLC

Provider Business Mailing Address
First Line	:	203 N INDUSTRIAL DR
Second Line	:	SUITE 3 & 4
City	:	ORANGE CITY
State	:	FL
Zip	:	32763-7418
Country	:	US
Telephone Number	:	386-490-0084
Fax Number	:	866-300-0779

Provider Business Practice Location Address
First Line	:	203 N INDUSTRIAL DR
Second Line	:	SUITE 3 & 4
City	:	ORANGE CITY
State	:	FL
Zip	:	32763-7418
Country	:	US
Telephone Number	:	386-490-0084
Fax Number	:	866-300-0779

Authorized Official
Title or Position	:	DIRECTOR/SUPPORT COORDINATOR
Name	:	LINDA L HOLLAND
Credential	:	WSC
Telephone Number	:	386-490-0084

Provider Enumeration Date	:	05/20/2013
Last Update Date	:	05/20/2013

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