Healthcare Provider Details

I. General information

NPI: 1225824790
Provider Name (Legal Business Name): TOTAL CARE CONNECTION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2025
Last Update Date: 04/19/2025
Certification Date: 04/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11604 SIDNEY CREST AVE
CHARLOTTE NC
28213-4870
US

IV. Provider business mailing address

11604 SIDNEY CREST AVE
CHARLOTTE NC
28213-4870
US

V. Phone/Fax

Practice location:
  • Phone: 252-469-3247
  • Fax:
Mailing address:
  • Phone: 252-469-3247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: SHANIYA RICHARDSON
Title or Position: PRESIDENT
Credential:
Phone: 252-469-3247