Healthcare Provider Details

I. General information

NPI: 1306540760
Provider Name (Legal Business Name): INDEPENDENCE CARE OF NORTH CAROLINA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2023
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1819 SARDIS RD N STE 350
CHARLOTTE NC
28270-2472
US

IV. Provider business mailing address

3301 BONITA BEACH RD STE 208
BONITA SPRINGS FL
34134-7835
US

V. Phone/Fax

Practice location:
  • Phone: 845-559-3081
  • Fax:
Mailing address:
  • Phone: 603-520-1603
  • 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 Code385HR2055X
TaxonomyChild Mental Illness Respite Care
License Number
License Number State

VIII. Authorized Official

Name: ALLISON VIAR
Title or Position: PRESIDENT
Credential:
Phone: 845-559-3081