Provider Demographics
NPI:1942792288
Name:NORTH CAROLINA COMMUNITY HOMES, LLC
Entity Type:Organization
Organization Name:NORTH CAROLINA COMMUNITY HOMES, LLC
Other - Org Name:HERITAGE MEADOWS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:DYSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-650-4635
Mailing Address - Street 1:4610 FAIRVISTA DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-1098
Mailing Address - Country:US
Mailing Address - Phone:046-504-6357
Mailing Address - Fax:
Practice Address - Street 1:6659 PRIVATE SCHOOL RD
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:NC
Practice Address - Zip Code:27565-7601
Practice Address - Country:US
Practice Address - Phone:919-693-5918
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-02
Last Update Date:2018-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility