Healthcare Provider Details

I. General information

NPI: 1477461515
Provider Name (Legal Business Name): CRESTWOOD GLOBAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4111E ROSE LAKE DR # 10238
CHARLOTTE NC
28217-2858
US

IV. Provider business mailing address

4111E ROSE LAKE DR # 10238
CHARLOTTE NC
28217-2858
US

V. Phone/Fax

Practice location:
  • Phone: 910-779-2597
  • Fax:
Mailing address:
  • Phone: 910-779-2597
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: JADA SHADEE MCEACHERN
Title or Position: CEO
Credential:
Phone: 910-779-2597