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Organization
CAROLINA VILLAGE COMMUNITY CARE, LLC
Active
Organization
CAROLINA VILLAGE COMMUNITY CARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENDRA JOHNSON (OWNER)
(704) 625-6598
Entity
Organization
Contact information
Practice address
1122 SAM NEWELL RD STE 103, MATTHEWS, NC 28105-5016
(704) 625-6598
Mailing address
1122 SAM NEWELL RD STE 103, MATTHEWS, NC 28105-5016
(704) 625-6598
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
253Z00000X
In Home Supportive Care Agency
Primary
—
—
343800000X
Secured Medical Transport (VAN)
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
—
347C00000X
Private Vehicle
—
—
385H00000X
Respite Care
—
—
385HR2055X
Child Mental Illness Respite Care
—
—
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
—
385HR2065X
Child Physical Disabilities Respite Care
—
—
Other
Enumeration date
12/28/2022
Last updated
09/14/2023
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