Healthcare Provider Details

I. General information

NPI: 1437013612
Provider Name (Legal Business Name): PATCHWORK COMMUNITY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

172 HARVEY OSTEEN RD
ZIRCONIA NC
28790-5701
US

IV. Provider business mailing address

172 HARVEY OSTEEN RD
ZIRCONIA NC
28790-5701
US

V. Phone/Fax

Practice location:
  • Phone: 828-388-7523
  • Fax:
Mailing address:
  • Phone: 828-388-7523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: WREN GEORGE
Title or Position: FOUNDER, PHYSICIAN ASSISTANT
Credential: DMS, PA-C, AAHIVS
Phone: 828-338-7523