Provider Demographics
NPI:1962653873
Name:PROFESSIONAL CARE LLC
Entity Type:Organization
Organization Name:PROFESSIONAL CARE LLC
Other - Org Name:PROFESSIONAL CARE LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERI
Authorized Official - Middle Name:T
Authorized Official - Last Name:ELLISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-484-1058
Mailing Address - Street 1:320 E GRAHAM ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28150-5568
Mailing Address - Country:US
Mailing Address - Phone:704-484-1058
Mailing Address - Fax:704-484-0787
Practice Address - Street 1:320 E GRAHAM ST
Practice Address - Street 2:SUITE 1
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-5568
Practice Address - Country:US
Practice Address - Phone:704-484-1058
Practice Address - Fax:704-484-0787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-09
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8302573Medicaid