Healthcare Provider Details

I. General information

NPI: 1659281723
Provider Name (Legal Business Name): BRANCHES SUPPORT SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10636 MOUNTAIN SPRINGS DR
CHARLOTTE NC
28278-7859
US

IV. Provider business mailing address

10636 MOUNTAIN SPRINGS DR
CHARLOTTE NC
28278-7859
US

V. Phone/Fax

Practice location:
  • Phone: 803-373-1916
  • Fax:
Mailing address:
  • Phone: 803-373-1916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SHEILA M JOHNSON
Title or Position: ADMINISTRATOR
Credential:
Phone: 803-373-1916