Healthcare Provider Details

I. General information

NPI: 1831703040
Provider Name (Legal Business Name): STONE BRIDE COMMUNITY PARTNERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2020
Last Update Date: 03/15/2022
Certification Date: 03/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1016 BLUE SKY DR NW
CONCORD NC
28027-7970
US

IV. Provider business mailing address

9625 DAVID TAYLOR DR STE 109
CHARLOTTE NC
28262-2362
US

V. Phone/Fax

Practice location:
  • Phone: 910-352-2023
  • Fax:
Mailing address:
  • Phone: 704-659-3753
  • Fax: 704-582-6027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MRS. SYREETA WATKINS REAVES
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: MSN, RN, NPD-BC
Phone: 910-352-2023