Provider Demographics
NPI:1457639031
Name:THE 4C COMPANY OF NC, LLC
Entity Type:Organization
Organization Name:THE 4C COMPANY OF NC, LLC
Other - Org Name:4C HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:WIGFALL
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:704-394-8968
Mailing Address - Street 1:3552 BEATTIES FORD RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-3742
Mailing Address - Country:US
Mailing Address - Phone:704-394-8968
Mailing Address - Fax:704-394-8967
Practice Address - Street 1:246 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:980-721-1573
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-29
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7806460Medicaid