=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083089742
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADVENT HEALTH SOLUTIONS, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/07/2015
-----------------------------------------------------
Last Update Date | 12/07/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 610 E 7TH ST STE 106
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28202-2923
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-453-1444
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 610 E 7TH ST STE 106
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28202-2923
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRINCIPAL OWNER
-----------------------------------------------------
Name | MR. JACQUES C JEAN SR.
-----------------------------------------------------
Credential | FNP-C
-----------------------------------------------------
Telephone | 704-453-1444
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number | 5007327
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------