Healthcare Provider Details

I. General information

NPI: 1881728152
Provider Name (Legal Business Name): CAROLINAS HOME CARE AGENCY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 05/14/2020
Certification Date: 05/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 S CANAL ST
WHITEVILLE NC
28472-4256
US

IV. Provider business mailing address

603 S CANAL ST
WHITEVILLE NC
28472-4256
US

V. Phone/Fax

Practice location:
  • Phone: 910-642-3700
  • Fax:
Mailing address:
  • Phone: 910-642-3700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License NumberMHL-024-077
License Number StateNC
# 5
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. MELODY CAMPBELL
Title or Position: EXECUTIVE DIRECTOR
Credential: QP
Phone: 910-642-3700