Healthcare Provider Details

I. General information

NPI: 1013201896
Provider Name (Legal Business Name): COMMUNITY EMBRACE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2011
Last Update Date: 06/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5309 E INDEPENDENCE BLVD STE E
CHARLOTTE NC
28212-0542
US

IV. Provider business mailing address

5309 E INDEPENDENCE BLVD STE E
CHARLOTTE NC
28212-0542
US

V. Phone/Fax

Practice location:
  • Phone: 980-229-2907
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: DAVID MCNEIL
Title or Position: COO
Credential:
Phone: 980-229-2907