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General NPI Number Information
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NPI Number | 1518216142
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Entity Type | Organization
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Legal Business Name | COMMUNITY CARE LINK OF THE CAROLINAS, INC
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Dates
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Enumeration Date | 08/29/2012
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Last Update Date | 02/07/2013
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Provider Practice Location Address
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Address Line | 756 TYVOLA RD STE 136
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City | CHARLOTTE
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State | NC
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Zip | 28217-3588
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Country | US
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Telephone | 980-322-7279
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Fax | 866-908-6945
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Provider Business Mailing Address
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Address Line | 756 TYVOLA RD STE 136
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City | CHARLOTTE
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State | NC
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Zip | 28217-3588
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Country | US
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Telephone | 980-322-7279
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Fax |
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Authorized Official
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Title or Position | EXECTIVE DIRECTOR
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Name | MONTOYA CHRISTIAN BOYD
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Credential | BSN,B.MSC
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Telephone | 980-322-7279
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | EN0829
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License Number State | SC
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