Healthcare Provider Details

I. General information

NPI: 1487561981
Provider Name (Legal Business Name): PALACE AT HOME CARE AGENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4422 AUSTIN DEKOTA DR
CHARLOTTE NC
28269-2153
US

IV. Provider business mailing address

4422 AUSTIN DEKOTA DR
CHARLOTTE NC
28269-2153
US

V. Phone/Fax

Practice location:
  • Phone: 704-977-3211
  • Fax:
Mailing address:
  • Phone: 704-977-3211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: BEVERLY DAVIS BEVERLY DAVIS
Title or Position: ADMINISTRATOR/DIRECTOR
Credential: DAVIS
Phone: 704-977-3211