Healthcare Provider Details

I. General information

NPI: 1326935099
Provider Name (Legal Business Name): STATE OF NORTH CAROLINA HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2025
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 W 4TH ST # 128
CHARLOTTE NC
28202-1545
US

IV. Provider business mailing address

227 W 4TH ST # 128
CHARLOTTE NC
28202-1545
US

V. Phone/Fax

Practice location:
  • Phone: 267-784-5115
  • Fax: 980-518-6801
Mailing address:
  • Phone: 267-784-5115
  • Fax: 980-518-6801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. ANDREW M BROOKER
Title or Position: OWNER/CEO
Credential:
Phone: 267-784-5115