Healthcare Provider Details

I. General information

NPI: 1487276242
Provider Name (Legal Business Name): ECHO PARK INTEGRATED INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2020
Last Update Date: 05/14/2020
Certification Date: 05/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 N TRYON ST
CHARLOTTE NC
28206-2721
US

IV. Provider business mailing address

3921 CAMERON CREEK DR
MATTHEWS NC
28105-6772
US

V. Phone/Fax

Practice location:
  • Phone: 704-604-5677
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: GRACE DAVID
Title or Position: PRESIDENT
Credential:
Phone: 704-604-5677