COMMUNITY CARE LINK OF THE CAROLINAS, INC (COMMUNITY CARE LINK) - NPI NUMBER 1518216142

Summary

Provider Name: COMMUNITY CARE LINK OF THE CAROLINAS, INC (COMMUNITY CARE LINK)

NPI Number: 1518216142

Clasification: Case Management (251B00000X)

Address:
756 TYVOLA RD
STE 136
CHARLOTTE, NC
ZIP 28217

Phone Number: (980) 322-7279



Detailed Information

COMMUNITY CARE LINK OF THE CAROLINAS, INC is a case management in Charlotte, NC. The provider is an organization that is responsible for providing case management services. The agency provides services which assist an individual in gaining access to needed medical, social, educational, and/or other services. Case management services may be used to locate, coordinate, and monitor necessary appropriate services. It may be used to encourage the use of cost-effective medical care by referrals to appropriate providers and to discourage over utilization of costly services. Case management may also serve to provide necessary coordination of non-medical services such as vocational rehabilitation, education, employment, when the services provided enable the individual to function at the highest level. The assigned NPI number for this provider is 1518216142 and is registered as an organization entity type.
The provider Is Doing Business As Community Care Link.

The provider's business address is:

756 TYVOLA RD
STE 136
CHARLOTTE, NC
ZIP 28217-588
Phone: (980) 322-7279
Fax: (866) 908-6945

The provider's authorized official is Montoya Christian Boyd .
The authorized official title is Exective Director and has the following contact phone number (980) 322-7279.

The enumeration date for this NPI number is 8/29/2012 and was last updated on 2/7/2013.

Map - Location of Practice

Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 251B00000X Case Management EN0829 SC Yes
2 251B00000X Case Management NC No

Other (Legacy) Identifiers

The following legacy identifiers are available for this provider:

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1 HIV CASE MGT MEDICAID NC

NPI Record

No. Field Name Field Value Field Definition 1
1 NPI 1518216142 The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
2 Entity Type Code 2 Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
3 Employer Identification Number EIN The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
4 Provider Organization Name Legal Business Name COMMUNITY CARE LINK OF THE CAROLINAS, INC The name of the organization provider. If the provider is an organization, this is the legal business name.
5 Provider Other Organization Name COMMUNITY CARE LINK Other name by which the organization provider is or has been known.
6 Provider Other Organization Name Type Code 3 Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other.
7 Provider First Line Business Practice Location Address 756 TYVOLA RD The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
8 Provider Second Line Business Practice Location Address STE 136 The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
9 Provider Business Practice Location Address City Name CHARLOTTE The city name in the location address of the provider being identified.
10 Provider Business Practice Location Address State Name NC The State code in the location of the provider being identified.
11 Provider Business Practice Location Address Postal Code 282173588 The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
12 Provider Business Practice Location Address Country Code If outside U S US The country code in the location address of the provider being identified.
13 Provider Business Practice Location Address Telephone Number 9803227279 The telephone number associated with the location address of the provider being identified.
14 Provider Business Practice Location Address Fax Number 8669086945 The fax number associated with the location address of the provider being identified.
15 Provider Enumeration Date 8/29/2012 The date the provider was assigned a unique identifier (assigned an NPI).
16 Last Update Date 2/7/2013 The date that a record was last updated or changed.
17 Authorized Official Last Name BOYD The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
18 Authorized Official First Name MONTOYA The first name of the authorized official.
19 Authorized Official Middle Name CHRISTIAN The middle name of the authorized official.
20 Authorized Official Title or Position EXECTIVE DIRECTOR The title or position of the authorized official.
21 Authorized Official Telephone Number 9803227279 The 10-position telephone number of the authorized official.
22 Healthcare Provider Taxonomy Code 1 251B00000X Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
23 Provider License Number 1 EN0829 The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
24 Provider License Number State Code 1 SC The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
25 Healthcare Provider Primary Taxonomy Switch 1 Y
26 Healthcare Provider Taxonomy Code 2 251B00000X
27 Provider License Number State Code 2 NC The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
28 Healthcare Provider Primary Taxonomy Switch 2 N
29 Other Provider Identifier 1 HIV CASE MGT Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
30 Other Provider Identifier Type Code 1 05 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
31 Other Provider Identifier State 1 NC
32 Is Organization Subpart N
33 Authorized Official Credential Text BSN,B.MSC

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This page was last updated on: 4/19/2015

(1) Field Definition Source-. Federal Register / Vol. 69, No. 15 / Friday, January 23, 2004 / Rules and Regulations - Part II Department of Health and Human Services Office of the Secretary 45 CFR Part 162 HIPAA Administrative Simplification: Standard Unique Health Identifier for Health Care Providers; Final Rule

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