MEDICARE: PERSONAL HOME CARE OF NORTH CAROLINA, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1073702437
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERSONAL HOME CARE OF NORTH CAROLINA, LLC

Provider Business Mailing Address
First Line	:	1515 MOCKINGBIRD LN STE 520
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28209-3297
Country	:	US
Telephone Number	:	704-522-6144
Fax Number	:	704-522-6145

Provider Business Practice Location Address
First Line	:	2460 INDIA HOOK RD STE 201G
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29732-3532
Country	:	US
Telephone Number	:	803-659-3350
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	IVAN BELOV
Credential	:
Telephone Number	:	704-522-6144

Provider Enumeration Date	:	10/22/2007
Last Update Date	:	11/20/2019

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