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NPI Code Detail

MEDICARE: CAROLINA HOMEHEALTH AGENCY LLC

MEDICARE: CAROLINA HOMEHEALTH AGENCY 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
1253Z00000XIn Home Supportive Care Agency

General Provider Information

NPI Number : 1528860210
Entity Type Code : Organization
Provider Name (Legal Business Name) : CAROLINA HOMEHEALTH AGENCY LLC
Provider Business Mailing Address
First Line : 1983 FAIRFOREST DR
Second Line :
City : FAYETTEVILLE
State : NC
Zip : 28304-2612
Country : US
Telephone Number : 910-541-5188
Fax Number :
Provider Business Practice Location Address
First Line : 1983 FAIRFOREST DR
Second Line :
City : FAYETTEVILLE
State : NC
Zip : 28304-2612
Country : US
Telephone Number : 910-541-5188
Fax Number :
Authorized Official
Title or Position : CEO
Name : DR. THEOPHILUS IMBUFE
Credential : DHA,MBA
Telephone Number : 910-733-3737
Provider Enumeration Date : 03/25/2025
Last Update Date : 06/23/2025

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Directions to “CAROLINA HOMEHEALTH AGENCY LLC ” Practice Location

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