NPI 1740775030 · live from the CMS NPI Registry
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Contractor in Charlotte, NC. National Provider Identifier 1740775030, active.
NPI record
| NPI | 1740775030 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Contractor 171W00000X |
| Practice location | 2600 W Trade St, Charlotte, NC 28208 |
| Practice phone | 704-607-4220 |
| Mailing address | 2201 Rozzelles Ferry Rd, Charlotte, NC 28208 |
| Enumerated | June 28, 2018 |
| Last updated | June 28, 2018 |
| Authorized official | Tylan Witherspoon, Director |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Behavior Analyst | 103K00000X | — (NC) |
| Marriage & Family Therapist | 106H00000X | — (NC) |
| Behavior Technician | 106S00000X | — (NC) |
| Personal Emergency Response Attendant | 146D00000X | — (NC) |
| Driver | 172A00000X | — (NC) |
| Community Health Worker | 172V00000X | — (NC) |
| Meals | 174200000X | — (NC) |
| Health Educator | 174H00000X | — (NC) |
| Dance Therapist | 225600000X | — (NC) |
| Recreation Therapist | 225800000X | — (NC) |
| Recreational Therapist Assistant | 226000000X | — (NC) |
| Home Health Aide | 374U00000X | — (NC) |
| Contractor primary | 171W00000X | — (NC) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.