Healthcare Provider Details

I. General information

NPI: 1801418942
Provider Name (Legal Business Name): CAROLINA COMMUNITY CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2020
Last Update Date: 09/21/2023
Certification Date: 09/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2275 INDIA HOOK RD
ROCK HILL SC
29732-1223
US

IV. Provider business mailing address

PO BOX 993
ROCK HILL SC
29731-6993
US

V. Phone/Fax

Practice location:
  • Phone: 803-329-1500
  • Fax: 803-329-9697
Mailing address:
  • Phone: 803-329-1500
  • Fax: 803-329-9697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER GRAHAM
Title or Position: CEO
Credential:
Phone: 803-329-1500