Healthcare Provider Details

I. General information

NPI: 1144725870
Provider Name (Legal Business Name): THE RENFREW CENTER OF N. CAROLINA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2018
Last Update Date: 03/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6633 FAIRVIEW ROAD
CHARLOTTE NC
28210
US

IV. Provider business mailing address

6633 FAIRVIEW RD
CHARLOTTE NC
28210-3321
US

V. Phone/Fax

Practice location:
  • Phone: 704-366-1264
  • Fax:
Mailing address:
  • Phone: 704-366-1264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code132700000X
TaxonomyDietary Manager
License Number
License Number State

VIII. Authorized Official

Name: MRS. SARAH STROUP
Title or Position: DIET TECHNICIAN
Credential:
Phone: 704-366-1264