Healthcare Provider Details

I. General information

NPI: 1417802018
Provider Name (Legal Business Name): PERSONAL HOME CARE OF NORTH CAROLINA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 OAKCREST AVE STE C
GREENSBORO NC
27408-4719
US

IV. Provider business mailing address

1515 MOCKINGBIRD LN STE 520
CHARLOTTE NC
28209-3297
US

V. Phone/Fax

Practice location:
  • Phone: 704-522-6144
  • Fax:
Mailing address:
  • Phone: 704-522-6144
  • 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: IVAN BELOV
Title or Position: DIRECTOR
Credential:
Phone: 704-522-6144