Provider Demographics
NPI:1053969162
Name:CAROLINA CARE AT HOME LLC
Entity type:Organization
Organization Name:CAROLINA CARE AT HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/AGENCY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PRABHU
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMKUMAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-230-1305
Mailing Address - Street 1:107 KILSON DR STE 106
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-8182
Mailing Address - Country:US
Mailing Address - Phone:704-230-1305
Mailing Address - Fax:
Practice Address - Street 1:107 KILSON DR STE 106
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-8182
Practice Address - Country:US
Practice Address - Phone:704-230-1305
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-01
Last Update Date:2019-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
No376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty