Provider Demographics
NPI:1669622973
Name:RATCLIFF, CHARLES HOWARD (HEALTH CARE PROVIDER)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:HOWARD
Last Name:RATCLIFF
Suffix:
Gender:M
Credentials:HEALTH CARE PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 RICHLAND STREET
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE,
Mailing Address - State:NC
Mailing Address - Zip Code:28806-4625
Mailing Address - Country:US
Mailing Address - Phone:828-281-4863
Mailing Address - Fax:828-281-9060
Practice Address - Street 1:75 KUYKENDALL BRANCH ROAD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE,
Practice Address - State:NC
Practice Address - Zip Code:28804-9612
Practice Address - Country:US
Practice Address - Phone:828-281-4863
Practice Address - Fax:828-281-9060
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-23
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL-011-276310400000X
NCFCL-011-275310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7805818Medicaid
NC7805827Medicaid