Healthcare Provider Details

I. General information

NPI: 1982510178
Provider Name (Legal Business Name): CONCRETE ROSE OPERATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5525 ALPINE LN
CHARLOTTE NC
28269-4519
US

IV. Provider business mailing address

19608 SMITH CIR
CORNELIUS NC
28031-9730
US

V. Phone/Fax

Practice location:
  • Phone: 828-569-5459
  • Fax:
Mailing address:
  • Phone: 203-770-9494
  • 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 Code261QR0800X
TaxonomyRecovery Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANDREW JOSEPH VITRIT
Title or Position: OWNER
Credential:
Phone: 203-770-9494