Provider Demographics
NPI:1386652089
Name:CAROLINA HOMECARE MEDICAL EQUIPMENT CTR
Entity Type:Organization
Organization Name:CAROLINA HOMECARE MEDICAL EQUIPMENT CTR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:BOLT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-271-8258
Mailing Address - Street 1:134 GARNER RD STE B
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29303-3132
Mailing Address - Country:US
Mailing Address - Phone:864-327-1487
Mailing Address - Fax:864-327-1491
Practice Address - Street 1:134 GARNER RD STE B
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-3132
Practice Address - Country:US
Practice Address - Phone:864-327-1487
Practice Address - Fax:864-327-1491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC332B00000X, 332BC3200X, 332BP3500X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0424540002Medicare NSC