Active NPI
Genesis of Carolinas Home Care, LLC
- Home Health Agency
- Charlotte, NC
National Provider Identifier
1295028710
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Home Health Agency
- License
- HC3994
- Legal business name
- GENESIS OF CAROLINAS HOME CARE, LLC
- Practice address
- 5736 North Tryon Street Suite 128
Charlotte, NC 28213-6891 - Phone
- (980) 207-3947
- Fax
- (980) 207-3956
- NPI assigned
- May 17, 2011
- Organization subpart
- Yes
- Parent organization
- GENESIS OF CAROLINAS HOME CARE, LLC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Ms. Octavia Devonne Shankle
- Title
- Owner/Director
- Phone
- (980) 207-3947
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | HC3994 | NC | Primary |
Addresses
Primary practice location
5736 North Tryon Street Suite 128
Charlotte, NC 28213-6891
Mailing address
5736 North Tryon Street Suite 128
Charlotte, NC 28213-6891
Phone (980) 207-3947
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3418972 | Medicaid | NC |
National Provider Directory
National Provider Directory- Tax ID family
- Genesis of Carolinas Home Care LLC
- Part of
- Genesis of Carolinas Home Care LLC
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Home Health Agency
- Charlotte, NC
- NPI 1700019486
Locations
5736 N Tryon St
Ste 128
Charlotte, NC 28213
Phone (980) 207-3947
Ownership & related parties
Parent organization (reported in NPPES) 1
This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.
-
- Home Health Agency
- Charlotte, NC
- NPI 1700019486
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1305590400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1564617600000",
"number": "1295028710",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5736 NORTH TRYON STREET SUITE 128",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282136891",
"telephone_number": "980-207-3947",
"fax_number": "980-207-3956"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5736 NORTH TRYON STREET SUITE 128",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282136891",
"telephone_number": "980-207-3947",
"fax_number": "980-207-3956"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "GENESIS OF CAROLINAS HOME CARE, LLC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "GENESIS OF CAROLINAS HOME CARE, LLC",
"enumeration_date": "2011-05-17",
"last_updated": "2019-08-01",
"status": "A",
"authorized_official_last_name": "SHANKLE",
"authorized_official_first_name": "OCTAVIA",
"authorized_official_middle_name": "DEVONNE",
"authorized_official_title_or_position": "OWNER/DIRECTOR",
"authorized_official_telephone_number": "980-207-3947",
"authorized_official_name_prefix": "Ms."
},
"taxonomies": [
{
"code": "251E00000X",
"taxonomy_group": "",
"desc": "Home Health",
"state": "NC",
"license": "HC3994",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3418972",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Charlotte, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.