Provider Demographics
NPI:1942674775
Name:THE CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY
Entity Type:Organization
Organization Name:THE CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY
Other - Org Name:STANLY MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT AND CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:A
Authorized Official - Last Name:GOMBAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-355-2154
Mailing Address - Street 1:PO BOX 602006
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2066
Mailing Address - Country:US
Mailing Address - Phone:704-512-4380
Mailing Address - Fax:
Practice Address - Street 1:625 BETHANY ROAD
Practice Address - Street 2:
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001
Practice Address - Country:US
Practice Address - Phone:704-984-7344
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-11-17
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNH0464314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility