NPIMap

Organization Active NPI

Genesis of Carolinas Home Care, LLC

  • Home Health Agency
  • Charlotte, NC
National Provider Identifier
1700019486
Registry record updated Aug 1, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
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
Aug 28, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2019

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X Primary
In Home Supportive Care Agency 253Z00000X 100027 NC

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

National Provider Directory

National Provider Directory
Tax ID family
Genesis of Carolinas Home Care LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1251417600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1564617600000",
    "number": "1700019486",
    "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": "NO",
        "enumeration_date": "2009-08-28",
        "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": null,
            "license": null,
            "primary": true
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": "NC",
            "license": "100027",
            "primary": false
        }
    ],
    "identifiers": [],
    "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.

Verify at the official NPI Registry.