Healthcare Provider Details

I. General information

NPI: 1295145563
Provider Name (Legal Business Name): THERACARE HEALTH & WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2014
Last Update Date: 09/13/2021
Certification Date: 09/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 S TRYON ST STE 2700
CHARLOTTE NC
28280-0005
US

IV. Provider business mailing address

PO BOX 5423
CLOVER SC
29710-5423
US

V. Phone/Fax

Practice location:
  • Phone: 704-749-8474
  • Fax:
Mailing address:
  • Phone: 704-930-9862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License NumberHC2834
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberHC2834
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: GREGORY PIPPINS
Title or Position: MEMBER LLC
Credential:
Phone: 704-930-9862