Healthcare Provider Details

I. General information

NPI: 1174995633
Provider Name (Legal Business Name): CAROLINAS MEDICAL CENTER AT HOME, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2015
Last Update Date: 03/30/2021
Certification Date: 03/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1061 ALBEMARLE RD
TROY NC
27371-8684
US

IV. Provider business mailing address

PO BOX 602259
CHARLOTTE NC
28260-2259
US

V. Phone/Fax

Practice location:
  • Phone: 704-982-2273
  • Fax:
Mailing address:
  • Phone: 704-512-2308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHC2404
License Number StateNC

VIII. Authorized Official

Name: MICHAEL ANTHONY STOLZENBACH
Title or Position: PRESIDENT
Credential:
Phone: 701-512-2312