Healthcare Provider Details

I. General information

NPI: 1275617284
Provider Name (Legal Business Name): CARE SOUTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3016 TWINS PL
BOONVILLE NC
27011-8961
US

IV. Provider business mailing address

3016 TWINS PL
BOONVILLE NC
27011-8961
US

V. Phone/Fax

Practice location:
  • Phone: 336-468-1710
  • Fax: 336-468-8709
Mailing address:
  • Phone: 336-468-1710
  • Fax: 336-468-8709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHC2086
License Number StateNC

VIII. Authorized Official

Name: MRS. DARA JESTER PURYEAR
Title or Position: OWNER DIRECTOR
Credential: REGISTERED NURSE
Phone: 336-468-1710