Healthcare Provider Details

I. General information

NPI: 1730197500
Provider Name (Legal Business Name): CAROLINA HOME CARE SPECIALISTS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 07/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 SKYVIEW CIRCLE
SPRUCE PINE NC
28777-9518
US

IV. Provider business mailing address

125 SKYVIEW CIRCLE PO BOX 549
SPRUCE PINE NC
28777-0549
US

V. Phone/Fax

Practice location:
  • Phone: 828-765-4343
  • Fax: 828-765-4340
Mailing address:
  • Phone: 828-765-4343
  • Fax: 828-765-4340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberHC2863
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License NumberHC2863
License Number StateNC

VIII. Authorized Official

Name: MRS. DONNA C. LUTTRELL
Title or Position: AGENCY DIRECTOR
Credential: R.N.
Phone: 828-765-4343