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General NPI Number Information
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NPI Number | 1699083899
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Entity Type | Organization
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Legal Business Name | PRIMARY CARE SOLUTIONS INC.
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Dates
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Enumeration Date | 09/22/2010
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Last Update Date | 10/26/2017
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Provider Practice Location Address
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Address Line | 5601 EXECUTIVE CENTER DR STE 200
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City | CHARLOTTE
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State | NC
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Zip | 28212-8841
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Country | US
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Telephone | 704-537-1022
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Fax | 704-569-0822
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Provider Business Mailing Address
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Address Line | 5601 EXECUTIVE CENTER DR STE 200
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City | CHARLOTTE
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State | NC
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Zip | 28212-8841
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Country | US
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Telephone | 704-537-1022
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Fax | 704-569-0822
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Authorized Official
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Title or Position | PRESIDENT
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Name | WILLIAM BULLOCK
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Credential |
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Telephone | 704-537-1022
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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 | MHL-060-1173
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License Number State | NC
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