Healthcare Provider Details

I. General information

NPI: 1154918704
Provider Name (Legal Business Name): ONE STEP TWO STEP OPERATION HOPE & AT RISK YOUTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2020
Last Update Date: 01/02/2021
Certification Date: 01/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 VILLAGE LAKE DR APT 150
CHARLOTTE NC
28212-0068
US

IV. Provider business mailing address

2121 VILLAGE LAKE DR APT 150
CHARLOTTE NC
28212-0068
US

V. Phone/Fax

Practice location:
  • Phone: 704-726-8645
  • Fax:
Mailing address:
  • Phone: 704-726-8645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code405300000X
TaxonomyPrevention Professional
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID J. KEITH
Title or Position: SENIOR V.P.
Credential: DO
Phone: 704-919-1733