Provider Demographics
NPI:1972365211
Name:SASSAFRAS TEA CO.
Entity Type:Organization
Organization Name:SASSAFRAS TEA CO.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ASIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-262-1247
Mailing Address - Street 1:1817 CRABAPPLE TREE LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28214-1063
Mailing Address - Country:US
Mailing Address - Phone:910-262-1247
Mailing Address - Fax:
Practice Address - Street 1:521 BRIAR CREEK RD STE A
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-6904
Practice Address - Country:US
Practice Address - Phone:980-227-1229
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No347C00000XTransportation ServicesPrivate VehicleGroup - Multi-Specialty
No405300000XOther Service ProvidersPrevention ProfessionalGroup - Multi-Specialty