Provider Demographics
NPI:1033343801
Name:HOMECARE FOR THE CAROLINAS
Entity Type:Organization
Organization Name:HOMECARE FOR THE CAROLINAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAMARAQ
Authorized Official - Middle Name:
Authorized Official - Last Name:NEELY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-535-8179
Mailing Address - Street 1:7402 FRANCES IRENE DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-9929
Mailing Address - Country:US
Mailing Address - Phone:704-335-8488
Mailing Address - Fax:704-335-8477
Practice Address - Street 1:7402 FRANCES IRENE DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215-9929
Practice Address - Country:US
Practice Address - Phone:704-335-8488
Practice Address - Fax:704-335-8477
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOMECARE FOR THE CAROLINAS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-05-08
Last Update Date:2009-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3551251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3418337Medicaid