MEDICARE: N PHASES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1568143477
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	N PHASES

Provider Business Mailing Address
First Line	:	6047 TYVOLA GLEN CIR STE 235
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28217-6436
Country	:	US
Telephone Number	:	980-745-7588
Fax Number	:

Provider Business Practice Location Address
First Line	:	6407 TYVOLA GLEN CIRCLE STE 235
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28217-6436
Country	:	US
Telephone Number	:	980-745-7588
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	WYVONNEA DENISE RIOS
Credential	:
Telephone Number	:	980-745-7588

Provider Enumeration Date	:	07/25/2023
Last Update Date	:	08/03/2023

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