Healthcare Provider Details

I. General information

NPI: 1477490365
Provider Name (Legal Business Name): CAROLINA HOME ACCESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11018 KING GEORGE LN
WAXHAW NC
28173-6817
US

IV. Provider business mailing address

11018 KING GEORGE LN
WAXHAW NC
28173-6817
US

V. Phone/Fax

Practice location:
  • Phone: 801-450-7716
  • Fax:
Mailing address:
  • Phone: 801-450-7716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN PHILLIPS
Title or Position: OWNER
Credential: CAPS, CEAC
Phone: 801-450-7716