Healthcare Provider Details

I. General information

NPI: 1841021227
Provider Name (Legal Business Name): CEDRIC DEAN HOLDINGS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2024
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 CATHERINE SIMMONS AVE
CHARLOTTE NC
28216-4677
US

IV. Provider business mailing address

5502 MCCHESNEY DR
CHARLOTTE NC
28269-7188
US

V. Phone/Fax

Practice location:
  • Phone: 704-492-5509
  • Fax:
Mailing address:
  • Phone: 704-492-5509
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: CEDRIC DEAN
Title or Position: CEO
Credential: CPSS
Phone: 704-492-5509