1518216142 NPI NUMBER - COMMUNITY CARE LINK OF THE CAROLINAS, INC
Summary
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NPI Number |
1518216142 |
| Entity Type Code |
Organization |
| Provider Legal Name |
COMMUNITY CARE LINK OF THE CAROLINAS, INC |
| Provider Business Practice Location Address |
756 TYVOLA RD
STE 136
CHARLOTTE, NC
ZIP 28217
|
| Practice Location Phone Number |
(980) 322-7279 |
| Provider Taxonomy Code |
251B00000X - Case Management |
| Specialization |
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| Provider Enumeration Date |
8/29/2012 |
| Last Update Date |
2/7/2013 |
NPI Number 1518216142 is assigned to an organization registered under the healthcare provider name COMMUNITY CARE LINK OF THE CAROLINAS, INC .
The provider is doing business as COMMUNITY CARE LINK .
The provider is physically located at:
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:
| 1 |
251B00000X |
Case Management |
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EN0829 |
SC |
View Code |
| 2 |
251B00000X |
Case Management |
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NC |
View Code |
Other (Legacy) Identifiers
The following legacy identifiers for this provider are available:
| 1 |
HIV CASE MGT |
MEDICAID |
NC |
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NPI Record
| 1 |
NPI |
1518216142 |
| 2 |
Entity Type Code |
2 |
| 3 |
Employer Identification Number EIN |
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| 4 |
Provider Organization Name Legal Business Name |
COMMUNITY CARE LINK OF THE CAROLINAS, INC |
| 5 |
Provider Other Organization Name |
COMMUNITY CARE LINK |
| 6 |
Provider Other Organization Name Type Code |
3 |
| 7 |
Provider First Line Business Practice Location Address |
756 TYVOLA RD |
| 8 |
Provider Second Line Business Practice Location Address |
STE 136 |
| 9 |
Provider Business Practice Location Address City Name |
CHARLOTTE |
| 10 |
Provider Business Practice Location Address State Name |
NC |
| 11 |
Provider Business Practice Location Address Postal Code |
282173588 |
| 12 |
Provider Business Practice Location Address Country Code If outside U S |
US |
| 13 |
Provider Business Practice Location Address Telephone Number |
9803227279 |
| 14 |
Provider Business Practice Location Address Fax Number |
8669086945 |
| 15 |
Provider Enumeration Date |
8/29/2012 |
| 16 |
Last Update Date |
2/7/2013 |
| 17 |
Authorized Official Last Name |
BOYD |
| 18 |
Authorized Official First Name |
MONTOYA |
| 19 |
Authorized Official Middle Name |
CHRISTIAN |
| 20 |
Authorized Official Title or Position |
EXECTIVE DIRECTOR |
| 21 |
Authorized Official Telephone Number |
9803227279 |
| 22 |
Healthcare Provider Taxonomy Code 1 |
251B00000X |
| 23 |
Provider License Number 1 |
EN0829 |
| 24 |
Provider License Number State Code 1 |
SC |
| 25 |
Healthcare Provider Primary Taxonomy Switch 1 |
Y |
| 26 |
Healthcare Provider Taxonomy Code 2 |
251B00000X |
| 27 |
Provider License Number State Code 2 |
NC |
| 28 |
Healthcare Provider Primary Taxonomy Switch 2 |
N |
| 29 |
Other Provider Identifier 1 |
HIV CASE MGT |
| 30 |
Other Provider Identifier Type Code 1 |
05 |
| 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: 5/14/2013
All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.