Provider Demographics
NPI:1770037327
Name:ADVANCED CARE NETWORK CHARLOTTE
Entity Type:Organization
Organization Name:ADVANCED CARE NETWORK CHARLOTTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GIVOANNI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHERRILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-749-4618
Mailing Address - Street 1:1801 N TRYON ST
Mailing Address - Street 2:SUITE 336
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28206-2704
Mailing Address - Country:US
Mailing Address - Phone:704-749-4618
Mailing Address - Fax:
Practice Address - Street 1:1801 N TRYON ST
Practice Address - Street 2:SUITE 336
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28206-2704
Practice Address - Country:US
Practice Address - Phone:704-749-4618
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-12
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC=========Medicaid