Healthcare Provider Details

I. General information

NPI: 1699561167
Provider Name (Legal Business Name): NC CARE HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2025
Last Update Date: 04/19/2025
Certification Date: 04/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6092 RALEIGH ST
SPRING HILL FL
34606-4045
US

IV. Provider business mailing address

6092 RALEIGH ST
SPRING HILL FL
34606-4045
US

V. Phone/Fax

Practice location:
  • Phone: 813-279-3151
  • Fax:
Mailing address:
  • Phone: 813-279-3151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. YADANY MACEIRA
Title or Position: CEO/ADMINISTRATOR
Credential:
Phone: 813-279-3151