Healthcare Provider Details

I. General information

NPI: 1104062967
Provider Name (Legal Business Name): TABONO CARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2008
Last Update Date: 10/30/2023
Certification Date: 10/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701 FREEDOM DR
CHARLOTTE NC
28208-2205
US

IV. Provider business mailing address

PO BOX 480428
CHARLOTTE NC
28269-5320
US

V. Phone/Fax

Practice location:
  • Phone: 704-395-9496
  • Fax: 866-431-2587
Mailing address:
  • Phone: 704-395-9496
  • Fax: 866-431-2587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberHC4110
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License NumberHC4110
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: TAMIKA LASHON CHISHOLM
Title or Position: MEMBER
Credential:
Phone: 704-395-9496