Get started with CareScout's Provider Program

Please submit the provider enrollment card below. If you are already enrolled in CareScout’s Provider Program and have a question, please email info@carescout.com.

*  Indicates a required field
*First Name: *Last Name:
Agent/Facility Name:
Tax ID/SSN:

Confirm Tax ID/SSN:

*Physical Address One: Physical Address Two:
*City: *State:
*Zip: *Email Address:
*Phone Number: Fax Number:
Mailing Address1: Mailing Address2:
City: State:
Zip:
*Please indicate which Provider Programs you are interested in joining:
*Please indicate your organization type:
Comments/Questions:
 


Contact Us By Mail

Attn: CareScout Provider Program

CareScout

60 Hickory Drive, 4th Floor

Waltham, MA 02451