Healthcare Provider Details

I. General information

NPI: 1578948832
Provider Name (Legal Business Name): CAROLINA CARE GIVER SERVICES,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2015
Last Update Date: 07/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 MEMORY PLZ
WHITEVILLE NC
28472-2640
US

IV. Provider business mailing address

110 MEMORY PLZ
WHITEVILLE NC
28472-2640
US

V. Phone/Fax

Practice location:
  • Phone: 910-654-1456
  • Fax: 910-516-2154
Mailing address:
  • Phone: 910-654-1456
  • Fax: 910-516-2154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MISS RACHEL MICHELLE MCDUFFIE
Title or Position: AGENCY DIRECTOR
Credential: CNA
Phone: 910-654-1456