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General NPI Number Information
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NPI Number | 1477177111
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Entity Type | Organization
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Legal Business Name | C&S ADULT CARE LLC
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Dates
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Enumeration Date | 05/28/2020
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Last Update Date | 03/07/2025
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Provider Practice Location Address
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Address Line | 1075 DEAL RD
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City | MOORESVILLE
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State | NC
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Zip | 28115-6719
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Country | US
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Telephone | 704-857-2817
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Fax | 704-857-1628
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Provider Business Mailing Address
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Address Line | PO BOX 8206
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City | LANDIS
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State | NC
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Zip | 28088-8206
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Country | US
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Telephone | 704-239-2199
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Fax |
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Authorized Official
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Title or Position | MEMBER MANAGER/OWNER
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Name | CASEY BLACK
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Credential |
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Telephone | 704-239-2199
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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