Provider Demographics
NPI:1518693191
Name:REGAL HOME CARE OF CHARLOTTE
Entity Type:Organization
Organization Name:REGAL HOME CARE OF CHARLOTTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:980-425-3345
Mailing Address - Street 1:525 S CHURCH ST APT 1905
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28202-3321
Mailing Address - Country:US
Mailing Address - Phone:980-425-3345
Mailing Address - Fax:
Practice Address - Street 1:227 W 4TH ST # 318
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28202-1545
Practice Address - Country:US
Practice Address - Phone:980-425-3345
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-27
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCHC6581OtherNC HOME CARE LICENSE