Provider Demographics
NPI:1518216142
Name:COMMUNITY CARE LINK OF THE CAROLINAS, INC
Entity Type:Organization
Organization Name:COMMUNITY CARE LINK OF THE CAROLINAS, INC
Other - Org Name:COMMUNITY CARE LINK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MONTOYA
Authorized Official - Middle Name:CHRISTIAN
Authorized Official - Last Name:BOYD
Authorized Official - Suffix:
Authorized Official - Credentials:BSN,BMSC
Authorized Official - Phone:980-322-7279
Mailing Address - Street 1:756 TYVOLA RD
Mailing Address - Street 2:STE 136
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28217-3588
Mailing Address - Country:US
Mailing Address - Phone:980-322-7279
Mailing Address - Fax:
Practice Address - Street 1:756 TYVOLA RD
Practice Address - Street 2:STE 136
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28217-3588
Practice Address - Country:US
Practice Address - Phone:980-322-7279
Practice Address - Fax:866-908-6945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-29
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCEN0829251B00000X
NC251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCHIV CASE MGTMedicaid