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General NPI Number Information
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NPI Number | 1124740386
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Entity Type | Organization
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Legal Business Name | QUEEN CITY COCOA BEANS INC
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Dates
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Enumeration Date | 09/14/2022
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Last Update Date | 01/10/2024
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Provider Practice Location Address
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Address Line | 2128 REMOUNT RD
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City | CHARLOTTE
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State | NC
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Zip | 28208-5051
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Country | US
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Telephone | 980-224-3748
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Fax |
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Provider Business Mailing Address
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Address Line | 10887 GARDEN OAKS LN
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City | CHARLOTTE
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State | NC
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Zip | 28273-4845
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Country | US
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Telephone | 980-224-7489
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR/ OWNER
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Name | MRS. RACHEL M DEAN
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Credential | MPH, RDN, LDN, IBCLC
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Telephone | 980-224-3748
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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