Provider Demographics
NPI:1558418541
Name:CHARLOTTE MANOR, LLC
Entity Type:Organization
Organization Name:CHARLOTTE MANOR, LLC
Other - Org Name:CHARLOTTE MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-333-4240
Mailing Address - Street 1:1003 MCARTHUR AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28206-1831
Mailing Address - Country:US
Mailing Address - Phone:704-333-4240
Mailing Address - Fax:
Practice Address - Street 1:1003 MCARTHUR AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28206-1831
Practice Address - Country:US
Practice Address - Phone:704-333-4240
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL060081310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility