Provider Demographics
NPI:1003063330
Name:CAROLINA CARE ONE, LLC.
Entity Type:Organization
Organization Name:CAROLINA CARE ONE, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CLAUDE
Authorized Official - Middle Name:BERNARD
Authorized Official - Last Name:MCRAE
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:704-299-2616
Mailing Address - Street 1:3601 BEAUX ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28208-4730
Mailing Address - Country:US
Mailing Address - Phone:704-299-2616
Mailing Address - Fax:
Practice Address - Street 1:3601 BEAUX ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28208-4730
Practice Address - Country:US
Practice Address - Phone:704-299-2616
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-18
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC000000000Medicaid