Provider Demographics
NPI: | 1043549298 |
---|---|
Name: | CHARLOTTE OPERATING AL, LLC |
Entity Type: | Organization |
Organization Name: | CHARLOTTE OPERATING AL, LLC |
Other - Org Name: | THE PARC AT SHARON AMITY |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | AUTHORIZED OFFICIAL |
Authorized Official - Prefix: | |
Authorized Official - First Name: | CHARLES |
Authorized Official - Middle Name: | E |
Authorized Official - Last Name: | TREFZGER |
Authorized Official - Suffix: | JR |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 828-261-7312 |
Mailing Address - Street 1: | PO BOX 2568 |
Mailing Address - Street 2: | |
Mailing Address - City: | HICKORY |
Mailing Address - State: | NC |
Mailing Address - Zip Code: | 28603-2568 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 4025 N SHARON AMITY RD |
Practice Address - Street 2: | |
Practice Address - City: | CHARLOTTE |
Practice Address - State: | NC |
Practice Address - Zip Code: | 28205-4975 |
Practice Address - Country: | US |
Practice Address - Phone: | 704-569-9661 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2009-12-17 |
Last Update Date: | 2009-12-17 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NC | 310400000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 310400000X | Nursing & Custodial Care Facilities | Assisted Living Facility |