Provider Demographics
NPI:1528477585
Name:CAROLINAS MEDICAL CENTER AT HOME LLC
Entity type:Organization
Organization Name:CAROLINAS MEDICAL CENTER AT HOME LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:STOLZENBACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-512-2312
Mailing Address - Street 1:PO BOX 602262
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2262
Mailing Address - Country:US
Mailing Address - Phone:704-403-5900
Mailing Address - Fax:704-403-5901
Practice Address - Street 1:3395 CLOVERLEAF PKWY
Practice Address - Street 2:
Practice Address - City:KANNAPOLIS
Practice Address - State:NC
Practice Address - Zip Code:28083-6991
Practice Address - Country:US
Practice Address - Phone:704-403-5900
Practice Address - Fax:704-403-5901
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAROLINAS MEDICAL CENTER AT HOME LLC DBA HEALTHY @ HOME CMC HOME INFUS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-08-04
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1528477585Medicaid