Provider Demographics
NPI:1245460906
Name:SPECIAL CARE SERVICE LLC
Entity type:Organization
Organization Name:SPECIAL CARE SERVICE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:KAY
Authorized Official - Middle Name:C
Authorized Official - Last Name:WASHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-949-5106
Mailing Address - Street 1:100 COASTLINE ST STE 314
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-5849
Mailing Address - Country:US
Mailing Address - Phone:252-937-5788
Mailing Address - Fax:252-937-5788
Practice Address - Street 1:100 COASTLINE ST STE 314
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-5849
Practice Address - Country:US
Practice Address - Phone:252-937-5788
Practice Address - Fax:252-937-5788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-15
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
NC251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty