Healthcare Provider Details

I. General information

NPI: 1104759281
Provider Name (Legal Business Name): THACH FAMILY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1413 ANDOVER RD
CHARLOTTE NC
28211-1809
US

IV. Provider business mailing address

1413 ANDOVER RD
CHARLOTTE NC
28211-1809
US

V. Phone/Fax

Practice location:
  • Phone: 704-618-0431
  • Fax:
Mailing address:
  • Phone: 704-618-0431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name: MR. WILLIAM THACH
Title or Position: CEO
Credential: CDP
Phone: 704-467-3607