1649050345 NPI number — CAROLINA THERAPEUTIC SERVICES COMMUNITY DEVELOPMENT INC

Table of content: (NPI 1649050345)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649050345 NPI number — CAROLINA THERAPEUTIC SERVICES COMMUNITY DEVELOPMENT INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAROLINA THERAPEUTIC SERVICES COMMUNITY DEVELOPMENT INC
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:
1649050345
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/02/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1528 UNION RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GASTONIA
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28054-2200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-864-1477
Provider Business Mailing Address Fax Number:
704-396-7524

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1781 TATE BLVD SE STE 202
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HICKORY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28602-4252
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-758-1320
Provider Business Practice Location Address Fax Number:
828-758-1332
Provider Enumeration Date:
10/02/2023

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SHIVADECKER
Authorized Official First Name:
HOLLY
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
704-864-1477

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LP0808X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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