Provider Demographics
| NPI: | 1417712555 |
|---|---|
| Name: | THE 4C COMPANY OF NC, LLC |
| Entity Type: | Organization |
| Organization Name: | THE 4C COMPANY OF NC, LLC |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | CEO |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | LISA |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | WIGFALL |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | MSW |
| Authorized Official - Phone: | 980-721-1573 |
| Mailing Address - Street 1: | 238 CHURCH ST NE |
| Mailing Address - Street 2: | |
| Mailing Address - City: | CONCORD |
| Mailing Address - State: | NC |
| Mailing Address - Zip Code: | 28025-4737 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 980-781-1051 |
| Mailing Address - Fax: | 980-781-1050 |
| Practice Address - Street 1: | 240 CHURCH ST NE |
| Practice Address - Street 2: | |
| Practice Address - City: | CONCORD |
| Practice Address - State: | NC |
| Practice Address - Zip Code: | 28025-4737 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 980-781-1051 |
| Practice Address - Fax: | |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2024-02-19 |
| Last Update Date: | 2024-02-19 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 343900000X | Transportation Services | Non-emergency Medical Transport (VAN) | ||
| No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Single Specialty | |
| No | 251B00000X | Agencies | Case Management | ||
| No | 251C00000X | Agencies | Day Training, Developmentally Disabled Services | ||
| No | 251S00000X | Agencies | Community/Behavioral Health | ||
| No | 252Y00000X | Agencies | Early Intervention Provider Agency | ||
| No | 253Z00000X | Agencies | In Home Supportive Care | ||
| No | 261QD1600X | Ambulatory Health Care Facilities | Clinic/Center | Developmental Disabilities | |
| No | 261QH0700X | Ambulatory Health Care Facilities | Clinic/Center | Hearing and Speech | |
| No | 261QM1300X | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | |
| No | 261QP2000X | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy | |
| No | 311ZA0620X | Nursing & Custodial Care Facilities | Custodial Care Facility | Adult Care Home | |
| No | 385H00000X | Respite Care Facility | Respite Care | ||
| No | 385HR2055X | Respite Care Facility | Respite Care | Respite Care, Mental Illness, Child | |
| No | 385HR2060X | Respite Care Facility | Respite Care | Respite Care, Intellectual and/or Developmental Disabilities, Child |
