Provider Demographics
NPI:1912062738
Name:TOTAL CARE, LLC
Entity type:Organization
Organization Name:TOTAL CARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AGENCY DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:KILLENSWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-494-2019
Mailing Address - Street 1:5020 TANGERINE DRIVE
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-5134
Mailing Address - Country:US
Mailing Address - Phone:910-494-2019
Mailing Address - Fax:910-920-3152
Practice Address - Street 1:5020 TANGERINE DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-5134
Practice Address - Country:US
Practice Address - Phone:910-494-2019
Practice Address - Fax:910-423-2868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3472251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6601560Medicaid