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Organization
GENESIS OF CAROLINAS HOME CARE, LLC
Active
Organization
GENESIS OF CAROLINAS HOME CARE, LLC
Active
Parent organization
GENESIS OF CAROLINAS HOME CARE, LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
GENESIS OF CAROLINAS HOME CARE, LLC
Authorized official
MS. OCTAVIA DEVONNE SHANKLE (OWNER/DIRECTOR)
(980) 207-3947
Entity
Organization
Contact information
Practice address
5736 NORTH TRYON STREET SUITE 128, CHARLOTTE, NC 28213-6891
(980) 207-3947
(980) 207-3956
Mailing address
5736 NORTH TRYON STREET SUITE 128, CHARLOTTE, NC 28213-6891
(980) 207-3947
(980) 207-3956
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
HC3994
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3418972
—
NC
Enumeration date
05/17/2011
Last updated
08/01/2019
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