MEDICARE: CAROLINAS MEDICAL CENTER AT HOME, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1245562735
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROLINAS MEDICAL CENTER AT HOME, LLC

Provider Business Mailing Address
First Line	:	PO BOX 32861
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28232-2861
Country	:	US
Telephone Number	:	704-512-5231
Fax Number	:	704-512-2428

Provider Business Practice Location Address
First Line	:	201 SAINT GERMAIN AVE SW
Second Line	:
City	:	VALDESE
State	:	NC
Zip	:	28690-2744
Country	:	US
Telephone Number	:	828-580-6641
Fax Number	:	828-580-6449

Authorized Official
Title or Position	:	CEO
Name	:	MS. HARRIETT C SARTAIN
Credential	:
Telephone Number	:	704-512-5231

Provider Enumeration Date	:	02/08/2010
Last Update Date	:	02/08/2010

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