Healthcare Provider Details

I. General information

NPI: 1376588749
Provider Name (Legal Business Name): SARDIS OAKS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 02/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5151 SARDIS RD
CHARLOTTE NC
28270-5291
US

IV. Provider business mailing address

PO BOX 32861
CHARLOTTE NC
28232-2861
US

V. Phone/Fax

Practice location:
  • Phone: 704-365-4202
  • Fax: 704-364-4901
Mailing address:
  • Phone: 704-512-6438
  • Fax: 704-512-6485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH0483
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. COLIN CLODE
Title or Position: ADMINISTRATOR
Credential:
Phone: 704-365-4202