Healthcare Provider Details

I. General information

NPI: 1124751706
Provider Name (Legal Business Name): CAROLINA CARE CONNECT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2022
Last Update Date: 01/03/2023
Certification Date: 01/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4332 TIMBERWOOD DR
GASTONIA NC
28056-8417
US

IV. Provider business mailing address

4332 TIMBERWOOD DR
GASTONIA NC
28056-8417
US

V. Phone/Fax

Practice location:
  • Phone: 216-334-6005
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code333300000X
TaxonomyEmergency Response System Companies
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: ANDRIA BYRD
Title or Position: OWNER/EXECUTIVE ADMINISTRATOR
Credential:
Phone: 704-534-1303