MEDICARE: AVANTE AT CHARLOTTE, INC.

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	313M00000X	Nursing Facility/Intermediate Care Facility	NH0267	NC
2	314000000X	Skilled Nursing Facility	NH0267	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891870804
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AVANTE AT CHARLOTTE, INC.

Provider Business Mailing Address
First Line	:	4000 HOLLYWOOD BLVD
Second Line	:	SUITE 540 NORTH
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-6751
Country	:	US
Telephone Number	:	954-987-7180
Fax Number	:	954-989-5287

Provider Business Practice Location Address
First Line	:	4801 RANDOLPH RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28211-2921
Country	:	US
Telephone Number	:	704-364-8363
Fax Number	:	704-365-6215

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. DEAN J DICKMANN
Credential	:
Telephone Number	:	954-987-7180

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	06/03/2008

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