Provider Demographics
NPI:1053619064
Name:SELECTCARE INC.
Entity type:Organization
Organization Name:SELECTCARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:R
Authorized Official - Last Name:LEIF
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:704-400-5460
Mailing Address - Street 1:3650 CENTRE CIR
Mailing Address - Street 2:UNIT H
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29715-8777
Mailing Address - Country:US
Mailing Address - Phone:888-902-9898
Mailing Address - Fax:
Practice Address - Street 1:3650 CENTRE CIR
Practice Address - Street 2:UNIT H
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29715-8777
Practice Address - Country:US
Practice Address - Phone:888-902-9898
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-01
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0436383332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7703041Medicaid
SCDE3395Medicaid
SCDE3395Medicaid
SC1247590002Medicare NSC