Healthcare Provider Details

I. General information

NPI: 1083449680
Provider Name (Legal Business Name): CAROLINA CARING SERIOUS ILLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2024
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3975 ROBINSON RD
NEWTON NC
28658-9715
US

IV. Provider business mailing address

3975 ROBINSON RD
NEWTON NC
28658-9715
US

V. Phone/Fax

Practice location:
  • Phone: 828-466-0466
  • Fax: 828-466-8862
Mailing address:
  • Phone: 828-466-0466
  • Fax: 828-466-8862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: TAMMY JENSEN
Title or Position: CFO
Credential:
Phone: 828-466-0466