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General NPI Number Information
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NPI Number | 1033031034
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Entity Type | Organization
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Legal Business Name | TRUE TRACE RESIDENTIAL HOME LLC
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Dates
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Enumeration Date | 07/29/2026
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Last Update Date | 07/29/2026
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Provider Practice Location Address
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Address Line | 1135 BRIDGEFIELD PL APT 107
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City | CHARLOTTE
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State | NC
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Zip | 28216-6030
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Country | US
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Telephone | 704-915-8786
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Fax |
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Provider Business Mailing Address
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Address Line | 1135 BRIDGEFIELD PL APT 107
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City | CHARLOTTE
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State | NC
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Zip | 28216-6030
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Country | US
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Telephone | 704-915-8786
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | QUANOLIA EUREKA SANDERS
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Credential |
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Telephone | 704-915-8786
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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