Provider Demographics
NPI:1275617284
Name:CARE SOUTH INC
Entity Type:Organization
Organization Name:CARE SOUTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DARA
Authorized Official - Middle Name:JESTER
Authorized Official - Last Name:PURYEAR
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:336-468-1710
Mailing Address - Street 1:3016 TWINS PL
Mailing Address - Street 2:
Mailing Address - City:BOONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27011-8961
Mailing Address - Country:US
Mailing Address - Phone:336-468-1710
Mailing Address - Fax:336-468-8709
Practice Address - Street 1:3016 TWINS PL
Practice Address - Street 2:
Practice Address - City:BOONVILLE
Practice Address - State:NC
Practice Address - Zip Code:27011-8961
Practice Address - Country:US
Practice Address - Phone:336-468-1710
Practice Address - Fax:336-468-8709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC2086251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3409349Medicaid
NC6600790Medicaid