Healthcare Provider Details

I. General information

NPI: 1437069291
Provider Name (Legal Business Name): HEARTH OF NC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9422 JOINES DR
MATTHEWS NC
28105-6528
US

IV. Provider business mailing address

9422 JOINES DR
MATTHEWS NC
28105-6528
US

V. Phone/Fax

Practice location:
  • Phone: 704-491-9970
  • Fax:
Mailing address:
  • Phone: 704-491-9970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MAULIK SHAH
Title or Position: OPERATING DIRECTOR
Credential:
Phone: 704-491-9970