Provider Demographics
NPI:1629195953
Name:ADMINISTRATIVE CARE SERVICES OF MADISON, INC.
Entity Type:Organization
Organization Name:ADMINISTRATIVE CARE SERVICES OF MADISON, INC.
Other - Org Name:HOT SPRINGS FCH #2
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:JOLENE
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-206-6399
Mailing Address - Street 1:P.O. BOX 41
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:NC
Mailing Address - Zip Code:28753
Mailing Address - Country:US
Mailing Address - Phone:828-206-6399
Mailing Address - Fax:828-622-9845
Practice Address - Street 1:311 N. SERPENTINE AVE.
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:28743
Practice Address - Country:US
Practice Address - Phone:828-206-6399
Practice Address - Fax:828-622-9845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
311Z00000X, 311ZA0620X
NCFCH-057-008311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7802065Medicaid