Healthcare Provider Details

I. General information

NPI: 1306625611
Provider Name (Legal Business Name): BS WAY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2023
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 NEWFOUND HOLLOW DR
CHARLOTTE NC
28214-4502
US

IV. Provider business mailing address

PO BOX 31323
CHARLOTTE NC
28231
US

V. Phone/Fax

Practice location:
  • Phone: 980-417-3190
  • Fax:
Mailing address:
  • Phone: 980-417-3190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number StateNULL

VIII. Authorized Official

Name: KELLY LACHELLE SMITH
Title or Position: COUNSELOR
Credential: MD
Phone: 562-743-8166