Healthcare Provider Details

I. General information

NPI: 1629559968
Provider Name (Legal Business Name): HOMECARE MANAGEMENT CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2018
Last Update Date: 08/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2818 QUEEN CITY DR STE E
CHARLOTTE NC
28208-2736
US

IV. Provider business mailing address

315 WILKESBORO BLVD NE STE 2A
LENOIR NC
28645-4498
US

V. Phone/Fax

Practice location:
  • Phone: 704-917-0230
  • Fax:
Mailing address:
  • Phone: 828-754-3665
  • Fax: 828-757-3195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MARLA KOONTZ
Title or Position: CFO
Credential:
Phone: 828-754-3665