Provider Demographics
NPI:1003419052
Name:CHARLOTTE SENIOR CARE, LLC
Entity Type:Organization
Organization Name:CHARLOTTE SENIOR CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:PEARCE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:980-580-6001
Mailing Address - Street 1:10135 HICKORYWOOD HILL AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-3426
Mailing Address - Country:US
Mailing Address - Phone:980-580-6100
Mailing Address - Fax:980-580-6004
Practice Address - Street 1:10135 HICKORYWOOD HILL AVE
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-3426
Practice Address - Country:US
Practice Address - Phone:980-580-6100
Practice Address - Fax:980-580-6004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health