MEDICARE: HOMECHOICE OF COASTAL 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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1366024168
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOMECHOICE OF COASTAL CAROLINA, LLC

Provider Business Mailing Address
First Line	:	4000 BLUE RIDGE RD STE 120
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27612-8061
Country	:	US
Telephone Number	:	919-897-8585
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 N MAIN ST STE 102
Second Line	:
City	:	FUQUAY VARINA
State	:	NC
Zip	:	27526-2056
Country	:	US
Telephone Number	:	919-557-4663
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	CAROL LYN BRANDENBURG
Credential	:
Telephone Number	:	919-897-8502

Provider Enumeration Date	:	04/22/2021
Last Update Date	:	12/08/2021

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