Provider Demographics
NPI:1083900948
Name:CARE-OLINA CARES, INCORPORATED
Entity Type:Organization
Organization Name:CARE-OLINA CARES, INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LAFAYETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACKMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-790-3302
Mailing Address - Street 1:PO BOX 43734
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-0028
Mailing Address - Country:US
Mailing Address - Phone:704-790-3302
Mailing Address - Fax:704-790-3302
Practice Address - Street 1:5736 N TRYON ST
Practice Address - Street 2:SUITE 226A
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28213-6850
Practice Address - Country:US
Practice Address - Phone:704-790-3302
Practice Address - Fax:704-790-3302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-20
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health