Healthcare Provider Details

I. General information

NPI: 1912832049
Provider Name (Legal Business Name): CCS LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 STRAW DR
STONY POINT NC
28678-2000
US

IV. Provider business mailing address

PO BOX 277
WOODLEAF NC
27054-0277
US

V. Phone/Fax

Practice location:
  • Phone: 704-267-2664
  • Fax:
Mailing address:
  • Phone: 704-267-2664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: CHARMAINE HAIRSTON
Title or Position: MANAGING MEMBER
Credential: BBA
Phone: 704-267-2664