Provider Demographics
NPI:1154495158
Name:CAROLINAS MEDICAL CENTER AT HOME, LLC
Entity Type:Organization
Organization Name:CAROLINAS MEDICAL CENTER AT HOME, LLC
Other - Org Name:ATRIUM HEALTH AT HOME BLUE RIDGE
Other - Org Type:Doing Business As
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 602259
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2259
Mailing Address - Country:US
Mailing Address - Phone:704-403-5267
Mailing Address - Fax:704-512-4035
Practice Address - Street 1:141 FIDDLERS RUN BLVD
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-0095
Practice Address - Country:US
Practice Address - Phone:828-580-6450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAROLINAS MEDICAL CENTER AT HOME LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-20
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC0105251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3407181Medicaid
NC347181Medicare ID - Type Unspecified