Healthcare Provider Details

I. General information

NPI: 1770448250
Provider Name (Legal Business Name): NOWELL CARE AT HOME, LLC AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 E PLAZA DR STE 118
MOORESVILLE NC
28115-8087
US

IV. Provider business mailing address

125 E PLAZA DR STE 118
MOORESVILLE NC
28115-8087
US

V. Phone/Fax

Practice location:
  • Phone: 980-276-3544
  • Fax:
Mailing address:
  • Phone: 980-276-3544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: OVELLA HOUSE NOWELL
Title or Position: ADMINISTRATOR / OWNER
Credential:
Phone: 980-276-3544