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General NPI Number Information
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NPI Number | 1215679121
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Entity Type | Organization
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Legal Business Name | CHARLOTTE DETOX CENTER, LLC
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Dates
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Enumeration Date | 04/11/2022
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Last Update Date | 04/11/2022
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Provider Practice Location Address
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Address Line | 7349 STATESVILLE RD STE B
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City | CHARLOTTE
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State | NC
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Zip | 28269-3702
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Country | US
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Telephone | 866-623-4948
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Fax |
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Provider Business Mailing Address
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Address Line | 28705 BENNINGTON DR
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City | WESLEY CHAPEL
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State | FL
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Zip | 33544-2831
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. CHRIS DOYLE
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Credential |
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Telephone | 813-610-3163
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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