Provider Demographics
NPI:1295145563
Name:THERACARE HEALTH & WELLNESS
Entity type:Organization
Organization Name:THERACARE HEALTH & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER LLC
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:PIPPINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-930-9862
Mailing Address - Street 1:PO BOX 5423
Mailing Address - Street 2:
Mailing Address - City:CLOVER
Mailing Address - State:SC
Mailing Address - Zip Code:29710-5423
Mailing Address - Country:US
Mailing Address - Phone:704-930-9862
Mailing Address - Fax:
Practice Address - Street 1:101 S TRYON ST STE 2700
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28280-0005
Practice Address - Country:US
Practice Address - Phone:704-749-8474
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-07
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC2834251J00000X, 253Z00000X
332B00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1295145563OtherWELLCARE
NC1295145563OtherAMERIHEALTH CARITAS
NC1295145563OtherUNITED HEALTHCARE
NC1295145563OtherCAROLINA COMPLETE HEALTH
NC1295145563OtherHEALTHY BLUE
NC1295145563Medicaid