Healthcare Provider Details

I. General information

NPI: 1225950868
Provider Name (Legal Business Name): FURTHER STAY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4111 ROSE LAKE DR # 9411
CHARLOTTE NC
28217-2829
US

IV. Provider business mailing address

4111 ROSE LAKE DR # 9411
CHARLOTTE NC
28217-2829
US

V. Phone/Fax

Practice location:
  • Phone: 704-835-6296
  • Fax:
Mailing address:
  • Phone: 704-835-6296
  • Fax: 704-835-6296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: LATOYA HARRIS
Title or Position: OWNER
Credential:
Phone: 704-835-6296