Provider Demographics
NPI:1669701330
Name:B&V PCS - CHARLOTTE
Entity type:Organization
Organization Name:B&V PCS - CHARLOTTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HEADEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-663-1366
Mailing Address - Street 1:1109 SUNRISE PL
Mailing Address - Street 2:
Mailing Address - City:SILER CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27344-9442
Mailing Address - Country:US
Mailing Address - Phone:919-663-1366
Mailing Address - Fax:919-663-1369
Practice Address - Street 1:8539 MONROE RD
Practice Address - Street 2:SUITE 105
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28212-7510
Practice Address - Country:US
Practice Address - Phone:704-536-3202
Practice Address - Fax:704-536-3203
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:B&V HOME CARE SERVICES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-12-09
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3570251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6601423Medicaid