=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689267551
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHESED CARE NETORK
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/11/2021
-----------------------------------------------------
Last Update Date | 02/18/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8824 BELLHAVEN BLVD
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28214-1349
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-796-6734
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8920 LAWYERS RD UNIT 691672
-----------------------------------------------------
City | MINT HILL
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28227-1400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-796-6734
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | EDWARD LILLY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 704-796-6734
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 374U00000X
-----------------------------------------------------
Taxonomy Name | Home Health Aide
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------