Provider Demographics
NPI:1831703040
Name:STONE BRIDE COMMUNITY PARTNERS, LLC
Entity type:Organization
Organization Name:STONE BRIDE COMMUNITY PARTNERS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SYREETA
Authorized Official - Middle Name:WATKINS
Authorized Official - Last Name:REAVES
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, RN, NPD-BC
Authorized Official - Phone:910-352-2023
Mailing Address - Street 1:9625 DAVID TAYLOR DR STE 109
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-2362
Mailing Address - Country:US
Mailing Address - Phone:704-659-3753
Mailing Address - Fax:704-582-6027
Practice Address - Street 1:1016 BLUE SKY DR NW
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-7970
Practice Address - Country:US
Practice Address - Phone:910-352-2023
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-04
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1831703040Medicaid