Healthcare Provider Details

I. General information

NPI: 1699610022
Provider Name (Legal Business Name): BREADWINNERS MANAGEMENT SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5330 CAMBRIDGE BAY DR
CHARLOTTE NC
28269-6115
US

IV. Provider business mailing address

5330 CAMBRIDGE BAY DR
CHARLOTTE NC
28269-6115
US

V. Phone/Fax

Practice location:
  • Phone: 704-421-0730
  • Fax:
Mailing address:
  • Phone: 704-421-0730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: JESSICA GILBERT HICKS
Title or Position: MANAGING MEMBER
Credential: MHRD, SPHR
Phone: 704-421-0730