Healthcare Provider Details

I. General information

NPI: 1366628885
Provider Name (Legal Business Name): INTERCARE HOME HEALTH SERVICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2008
Last Update Date: 11/22/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 W 24TH STREET 311 W 24TH STREET
CHARLOTTE NC
28206
US

IV. Provider business mailing address

311 W 24TH STREET 311 W 24 STREET
CHARLOTTE NC
28206
US

V. Phone/Fax

Practice location:
  • Phone: 704-332-9880
  • Fax: 704-332-9890
Mailing address:
  • Phone: 704-332-9880
  • Fax: 704-332-9890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number208IH0002X
License Number StateNC

VIII. Authorized Official

Name: MRS. NGOZI NNAJI
Title or Position: DIRECTOR
Credential: RN
Phone: 704-332-9880