Provider Demographics
NPI:1679623193
Name:CARROLTON HOME CARE INCORPORATED
Entity type:Organization
Organization Name:CARROLTON HOME CARE INCORPORATED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT LEGAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HALE
Authorized Official - Suffix:
Authorized Official - Credentials:PA, RN
Authorized Official - Phone:252-467-1389
Mailing Address - Street 1:800 TIFFANY BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-1946
Mailing Address - Country:US
Mailing Address - Phone:252-467-1393
Mailing Address - Fax:252-937-2647
Practice Address - Street 1:216 BEAMAN ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NC
Practice Address - Zip Code:28328-2906
Practice Address - Country:US
Practice Address - Phone:252-467-1393
Practice Address - Fax:252-937-2647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8700325Medicaid