Healthcare Provider Details

I. General information

NPI: 1093858623
Provider Name (Legal Business Name): ORIOLE PLACE ADULT CARE HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 10/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3505 ORIOLE PL
CHARLOTTE NC
28269-1214
US

IV. Provider business mailing address

3505 ORIOLE PL
CHARLOTTE NC
28269-1214
US

V. Phone/Fax

Practice location:
  • Phone: 704-494-4731
  • Fax: 704-494-4731
Mailing address:
  • Phone: 704-494-4731
  • Fax: 704-494-4731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License NumberFCL-060-084
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License NumberFCL-060-084
License Number StateNC

VIII. Authorized Official

Name: MILDRED M PHILIPPE-AUGUSTE
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 704-494-4731