Healthcare Provider Details

I. General information

NPI: 1316693195
Provider Name (Legal Business Name): CAREGIVERS TO GO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2022
Last Update Date: 03/07/2022
Certification Date: 03/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7189 WATERWHEEL ST SW
CONCORD NC
28025-6748
US

IV. Provider business mailing address

7189 WATERWHEEL ST SW
CONCORD NC
28025-6748
US

V. Phone/Fax

Practice location:
  • Phone: 469-703-1669
  • Fax:
Mailing address:
  • Phone: 469-703-1669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385HR2055X
TaxonomyChild Mental Illness Respite Care
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385HR2065X
TaxonomyChild Physical Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: JACKIE SULLIVAN
Title or Position: CEO
Credential:
Phone: 800-217-8015