Provider Demographics
NPI:1528860210
Name:CAROLINA HOMEHEALTH AGENCY LLC
Entity type:Organization
Organization Name:CAROLINA HOMEHEALTH AGENCY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:THEOPHILUS
Authorized Official - Middle Name:
Authorized Official - Last Name:IMBUFE
Authorized Official - Suffix:
Authorized Official - Credentials:DHA,MBA
Authorized Official - Phone:910-733-3737
Mailing Address - Street 1:1983 FAIRFOREST DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-2612
Mailing Address - Country:US
Mailing Address - Phone:910-541-5188
Mailing Address - Fax:
Practice Address - Street 1:1983 FAIRFOREST DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-2612
Practice Address - Country:US
Practice Address - Phone:910-541-5188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-25
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health