1518244177 NPI number — AVANT GARDE HOME CARE SERVICES

Table of content: MRS. SUSAN CLAIR PARK PT (NPI 1922253673)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518244177 NPI number — AVANT GARDE HOME CARE SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AVANT GARDE HOME CARE SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518244177
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/27/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9700 RESEARCH DRIVE
Provider Second Line Business Mailing Address:
SUITE 109
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28262-8569
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-549-8006
Provider Business Mailing Address Fax Number:
704-405-4226

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9700 RESEARCH DRIVE
Provider Second Line Business Practice Location Address:
SUITE 109
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28262-8569
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-549-8006
Provider Business Practice Location Address Fax Number:
704-405-4226
Provider Enumeration Date:
11/10/2011

Additional Information

Authorized Official

Authorized Official Last Name:
GREGORY
Authorized Official First Name:
BELINDA
Authorized Official Middle Name:
MCFADDEN
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
704-549-8006

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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