Healthcare Provider Details

I. General information

NPI: 1194602318
Provider Name (Legal Business Name): CARTER ENTERPRISES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2025
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 UNIVERSITY AVE W
SAINT PAUL MN
55104-4805
US

IV. Provider business mailing address

770 UNIVERSITY AVE W
SAINT PAUL MN
55104-4805
US

V. Phone/Fax

Practice location:
  • Phone: 347-325-4288
  • Fax:
Mailing address:
  • Phone: 347-325-4288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL TADROS
Title or Position: OWNER
Credential:
Phone: 347-325-4288