Healthcare Provider Details

I. General information

NPI: 1790788057
Provider Name (Legal Business Name): CAROLINA VITAL CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 10/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 W CORBETT AVE SUITE B
SWANSBORO NC
28584-8452
US

IV. Provider business mailing address

PO BOX 961
SWANSBORO NC
28584-0961
US

V. Phone/Fax

Practice location:
  • Phone: 910-326-7948
  • Fax: 910-326-5480
Mailing address:
  • Phone: 910-326-7948
  • Fax: 910-326-5480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberHC1403
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License NumberHC1403
License Number StateNC

VIII. Authorized Official

Name: MR. JERRY A. STANLEY IV
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 252-726-3556