| Cumberland County Communicare, Inc | |
|
711b Executive Pl Fayetteville NC 28305-5125 | |
| (910) 222-6395 | |
| Not Available |
| Full Name | Cumberland County Communicare, Inc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 711b Executive Pl, Fayetteville, North Carolina |
| Authorized Official Name and Position | Robin Jenkins (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 9108299017 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Cumberland County Communicare, Inc Po Box 87830 Fayetteville NC 28304-7830 Ph: (910) 222-6395 | Cumberland County Communicare, Inc 711b Executive Pl Fayetteville NC 28305-5125 Ph: (910) 222-6395 |
| NPI Number | 1255539870 |
|---|---|
| Provider Enumeration Date | 07/05/2007 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 8820368640 |
|---|---|
| Medicare Enrollment ID | O20190930000399 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255539870 | NPI | - | NPPES |
| 8301516Q | Medicaid | NC | |
| 8301516B | Medicaid | NC | |
| 8301516 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | MHL-026821 (North Carolina) | Primary |
| Provider Name | Kenneth Gregory Smith |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1356397004 PECOS PAC ID: 4082719380 Enrollment ID: I20070416000222 |
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