Healthcare Provider Details

I. General information

NPI: 1669868972
Provider Name (Legal Business Name): HOMECARE FOR THE CAROLINAS CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2015
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 MORRIS PARK DR STE 14
MINT HILL NC
28227-8253
US

IV. Provider business mailing address

13048 ODELL HEIGHTS DR
MINT HILL NC
28227-4388
US

V. Phone/Fax

Practice location:
  • Phone: 704-335-8488
  • Fax:
Mailing address:
  • Phone: 704-724-7041
  • Fax: 704-335-8477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: TAMARA NEELY
Title or Position: BILLING DIRECTOR
Credential:
Phone: 704-335-8488