Provider Demographics
NPI:1558057455
Name:AFFILIATED SANTE GROUP
Entity Type:Organization
Organization Name:AFFILIATED SANTE GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ROBYN
Authorized Official - Middle Name:
Authorized Official - Last Name:CODRINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:341-070-4566
Mailing Address - Street 1:810 TYVOLA RD STE 126
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28217-3536
Mailing Address - Country:US
Mailing Address - Phone:704-566-3410
Mailing Address - Fax:
Practice Address - Street 1:810 TYVOLA RD STE 126
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28217-3536
Practice Address - Country:US
Practice Address - Phone:704-566-3410
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AFFILIATED SANTE GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-04-13
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health