Healthcare Provider Details

I. General information

NPI: 1962214403
Provider Name (Legal Business Name): S S PCS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2025
Last Update Date: 02/26/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 E ARROWHEAD DR STE 3
CHARLOTTE NC
28213-6456
US

IV. Provider business mailing address

3020 PROSPERITY CHURCH RD # 243
CHARLOTTE NC
28269-7197
US

V. Phone/Fax

Practice location:
  • Phone: 704-352-0467
  • Fax:
Mailing address:
  • Phone: 704-352-0467
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: LATOYA S D SCOTT
Title or Position: MANGER
Credential:
Phone: 704-352-0467