Healthcare Provider Details

I. General information

NPI: 1689201451
Provider Name (Legal Business Name): EXCLUSIVE CARING PARTNERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2020
Last Update Date: 12/09/2020
Certification Date: 07/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 ROOK RD
CHARLOTTE NC
28216-3199
US

IV. Provider business mailing address

412 ROOK RD
CHARLOTTE NC
28216-3199
US

V. Phone/Fax

Practice location:
  • Phone: 980-207-4791
  • Fax:
Mailing address:
  • Phone:
  • 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 State
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: WALTER YOUNG JR.
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 980-886-6680