Provider Demographics
NPI:1720214174
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 HME CLEVELAND
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 602262
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2262
Mailing Address - Country:US
Mailing Address - Phone:704-512-5231
Mailing Address - Fax:
Practice Address - Street 1:105 T R HARRIS DR
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-3486
Practice Address - Country:US
Practice Address - Phone:704-487-5225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-29
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1720212174Medicaid