MEDICARE: CARE SOURCE 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	253Z00000X	In Home Supportive Care Agency	HP0103900	NJ

General Provider Information

NPI Number	:	1972811032
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARE SOURCE LLC

Provider Business Mailing Address
First Line	:	PO BOX 1755
Second Line	:
City	:	BELLMAWR
State	:	NJ
Zip	:	08099-1755
Country	:	US
Telephone Number	:	856-552-1518
Fax Number	:	267-295-7943

Provider Business Practice Location Address
First Line	:	200 FEDERAL ST
Second Line	:	SUITE 208
City	:	CAMDEN
State	:	NJ
Zip	:	08103-1061
Country	:	US
Telephone Number	:	856-552-1518
Fax Number	:	267-295-7943

Authorized Official
Title or Position	:	BILLING DIRECTOR
Name	:	MRS. SAMANTHA R BATDORF
Credential	:
Telephone Number	:	856-552-1518

Provider Enumeration Date	:	09/22/2010
Last Update Date	:	09/22/2010

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