Healthcare Provider Details

I. General information

NPI: 1326910415
Provider Name (Legal Business Name): CRAVEN TERRACE CHARITIES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2025
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10085 RIO SAN DIEGO DR APT 337
SAN DIEGO CA
92108-5680
US

IV. Provider business mailing address

109 FAWN TRL
JACKSONVILLE NC
28540-4595
US

V. Phone/Fax

Practice location:
  • Phone: 252-626-7732
  • Fax:
Mailing address:
  • Phone: 252-626-7732
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSHUA M CHITALO
Title or Position: BUSINESS DIRECTOR
Credential:
Phone: 252-626-7732