1730197500 NPI number — CAROLINA HOME CARE SPECIALISTS, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730197500 NPI number — CAROLINA HOME CARE SPECIALISTS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAROLINA HOME CARE SPECIALISTS, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730197500
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/12/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
125 SKYVIEW CIRCLE
Provider Second Line Business Mailing Address:
PO BOX 549
Provider Business Mailing Address City Name:
SPRUCE PINE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28777-0549
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-765-4343
Provider Business Mailing Address Fax Number:
828-765-4340

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
125 SKYVIEW CIRCLE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRUCE PINE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28777-9518
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-765-4343
Provider Business Practice Location Address Fax Number:
828-765-4340
Provider Enumeration Date:
08/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LUTTRELL
Authorized Official First Name:
DONNA
Authorized Official Middle Name:
C.
Authorized Official Title or Position:
AGENCY DIRECTOR
Authorized Official Telephone Number:
828-765-4343

Provider Taxonomy Codes

  • Taxonomy code: 3747P1801X , with the licence number:  HC2863 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 253Z00000X , with the licence number: HC2863 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3408152 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6601196 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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