Healthcare Provider Details

I. General information

NPI: 1023928132
Provider Name (Legal Business Name): EXECUTIVE CAR SERVICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

756 TYVOLA RD STE 119
CHARLOTTE NC
28217-3535
US

IV. Provider business mailing address

756 TYVOLA RD STE 119
CHARLOTTE NC
28217-3535
US

V. Phone/Fax

Practice location:
  • Phone: 704-525-2191
  • Fax:
Mailing address:
  • Phone: 704-525-2191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: MR. JEROME ALLEN MOE
Title or Position: PRESIDENT
Credential:
Phone: 704-525-2191