MEDICARE: INDEPENDENCE 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	385HR2055X	Child Mental Illness Respite Care
2	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1306540760
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDEPENDENCE CARE OF NORTH CAROLINA LLC

Provider Business Mailing Address
First Line	:	3301 BONITA BEACH RD STE 208
Second Line	:
City	:	BONITA SPRINGS
State	:	FL
Zip	:	34134-7835
Country	:	US
Telephone Number	:	603-520-1603
Fax Number	:

Provider Business Practice Location Address
First Line	:	1819 SARDIS RD N STE 350
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28270-2472
Country	:	US
Telephone Number	:	845-559-3081
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ALLISON VIAR
Credential	:
Telephone Number	:	845-559-3081

Provider Enumeration Date	:	03/29/2023
Last Update Date	:	05/28/2026

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