Provider Demographics
NPI:1386054146
Name:CAREOLINA HOME CARE SERVICES LLC
Entity type:Organization
Organization Name:CAREOLINA HOME CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SAMONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKENNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-790-3302
Mailing Address - Street 1:5736 N TRYON ST
Mailing Address - Street 2:STE 220
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-6850
Mailing Address - Country:US
Mailing Address - Phone:704-790-3302
Mailing Address - Fax:704-910-5564
Practice Address - Street 1:5736 N TRYON ST
Practice Address - Street 2:STE 220
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28213-6850
Practice Address - Country:US
Practice Address - Phone:704-790-3302
Practice Address - Fax:704-910-5564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-02
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3948251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCHC3948Medicaid