Healthcare Provider Details

I. General information

NPI: 1285890145
Provider Name (Legal Business Name): CAROLINA FAMILY CARE HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2008
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5816 WILLOW POINT DR
MORGANTON NC
28655-8602
US

IV. Provider business mailing address

302 CHARLES AVE
MORGANTON NC
28655-9059
US

V. Phone/Fax

Practice location:
  • Phone: 828-390-4370
  • Fax: 828-390-4370
Mailing address:
  • Phone: 828-390-4370
  • Fax: 828-391-1207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberFCL-012-035
License Number StateNC

VIII. Authorized Official

Name: MR. BOBBY LYNN JOLLY
Title or Position: PRESIDENT/ ONWER
Credential:
Phone: 828-390-4370