Healthcare Provider Details

I. General information

NPI: 1164967444
Provider Name (Legal Business Name): CHARLOTTE HEALTH INITIATIVE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2016
Last Update Date: 12/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4115 THE PLZ
CHARLOTTE NC
28205-1356
US

IV. Provider business mailing address

PO BOX 1280
MATTHEWS NC
28106-1280
US

V. Phone/Fax

Practice location:
  • Phone: 704-493-9626
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: AMAKA EKWONU
Title or Position: DIRECTOR
Credential:
Phone: 704-493-9626