MEDICARE: NC CARE ESSENTIALS

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	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1245192772
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NC CARE ESSENTIALS

Provider Business Mailing Address
First Line	:	4623 MANCHINEEL LN
Second Line	:
City	:	MONROE
State	:	NC
Zip	:	28110-9197
Country	:	US
Telephone Number	:	202-779-2947
Fax Number	:	202-779-2947

Provider Business Practice Location Address
First Line	:	4623 MANCHINEEL LN
Second Line	:
City	:	MONROE
State	:	NC
Zip	:	28110-9197
Country	:	US
Telephone Number	:	202-779-2947
Fax Number	:	202-779-2947

Authorized Official
Title or Position	:	OWENER
Name	:	SHANA JEWAN GUY
Credential	:
Telephone Number	:	202-779-2947

Provider Enumeration Date	:	12/02/2025
Last Update Date	:	12/02/2025

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Directions to “NC CARE ESSENTIALS ” Practice Location

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