Provider Demographics
NPI:1790788057
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:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:A
Authorized Official - Last Name:STANLEY
Authorized Official - Suffix:IV
Authorized Official - Credentials:
Authorized Official - Phone:252-726-3556
Mailing Address - Street 1:PO BOX 961
Mailing Address - Street 2:
Mailing Address - City:SWANSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28584-0961
Mailing Address - Country:US
Mailing Address - Phone:910-326-7948
Mailing Address - Fax:910-326-5480
Practice Address - Street 1:706 W CORBETT AVE
Practice Address - Street 2:SUITE B
Practice Address - City:SWANSBORO
Practice Address - State:NC
Practice Address - Zip Code:28584-8452
Practice Address - Country:US
Practice Address - Phone:910-326-7948
Practice Address - Fax:910-326-5480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-31
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC1403332B00000X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
3413488OtherNABP
NC0675512Medicaid
=========OtherTAX ID
NC7701801Medicare Oscar/Certification
NC0675512Medicaid