Provider Demographics
NPI:1306849609
Name:CAROLINA VITAL CARE, INC
Entity Type:Organization
Organization Name:CAROLINA VITAL CARE, INC
Other - Org Name:CVC HOME MEDICAL, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CORPORATE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:A
Authorized Official - Last Name:STANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-726-3556
Mailing Address - Street 1:PO BOX 684
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-0684
Mailing Address - Country:US
Mailing Address - Phone:252-726-3556
Mailing Address - Fax:252-726-4227
Practice Address - Street 1:3302 BRIDGES ST STE C
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-3366
Practice Address - Country:US
Practice Address - Phone:252-726-3556
Practice Address - Fax:252-726-3556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-31
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC1690332B00000X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7702798Medicaid
3413488OtherNABP
=========OtherTAX ID
NC7702798Medicare Oscar/Certification
3413488OtherNABP