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General NPI Number Information
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NPI Number | 1407164361
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Entity Type | Organization
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Legal Business Name | CAROLINA HOME CARE,LLC
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Dates
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Enumeration Date | 09/14/2010
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Last Update Date | 09/14/2010
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Provider Practice Location Address
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Address Line | 105 EAST BROAD STREET
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City | ELIZABETHTOWN
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State | NC
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Zip | 28337
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Country | US
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Telephone | 910-862-2600
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Fax | 910-862-8400
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Provider Business Mailing Address
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Address Line | PO BOX 1165
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City | ELIZABETHTOWN
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State | NC
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Zip | 28337
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Country | US
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Telephone | 910-862-2600
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Fax | 910-862-8400
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. JACQUELINE MONTRESS STALLWORTH
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Credential |
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Telephone | 910-242-2956
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | HC4169
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License Number State | NC
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