Provider Demographics
NPI:1104913326
Name:CAROLINAS UNION HEALTHCARE, INC
Entity type:Organization
Organization Name:CAROLINAS UNION HEALTHCARE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-296-4057
Mailing Address - Street 1:PO BOX 633
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28111-0633
Mailing Address - Country:US
Mailing Address - Phone:704-226-2001
Mailing Address - Fax:704-226-2000
Practice Address - Street 1:1403 DOVE ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-5014
Practice Address - Country:US
Practice Address - Phone:704-226-2001
Practice Address - Fax:704-226-2000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12093416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3406853Medicaid
SCAB0179OtherSC MEDICAID
NC3406853Medicaid