Healthcare Provider Details

I. General information

NPI: 1760991806
Provider Name (Legal Business Name): CC ELDERLY CARE CONNECTION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2017
Last Update Date: 09/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 BW THOMAS DR
FORT MILL SC
29708-7230
US

IV. Provider business mailing address

1711 COPPERPLATE RD
CHARLOTTE NC
28262-6435
US

V. Phone/Fax

Practice location:
  • Phone: 980-200-5370
  • Fax:
Mailing address:
  • Phone: 980-200-5370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State

VIII. Authorized Official

Name: MISS DOMINIQUE SEQUIOA HAMRICK
Title or Position: OWNER
Credential:
Phone: 980-200-5370