Healthcare Provider Details

I. General information

NPI: 1619853322
Provider Name (Legal Business Name): CAROLINA HOMECARE GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2025
Last Update Date: 08/17/2025
Certification Date: 08/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3466 HENDERSON DR STE 27
JACKSONVILLE NC
28546-5232
US

IV. Provider business mailing address

3225 MCLEOD DR # 100
LAS VEGAS NV
89121-2257
US

V. Phone/Fax

Practice location:
  • Phone: 910-729-6392
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. IRMEEN M ASHRAF
Title or Position: CEO
Credential: MD
Phone: 510-579-8332