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General NPI Number Information
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NPI Number | 1780921148
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Entity Type | Organization
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Legal Business Name | CEICARE THERAPEUTIC DEVELOPMENT & HEALTH RESOURCE MANAGEMENT
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Dates
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Enumeration Date | 01/04/2013
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Last Update Date | 01/04/2013
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Provider Practice Location Address
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Address Line | 3020 PROSPERITY CHURCH RD UNIT 178
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City | CHARLOTTE
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State | NC
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Zip | 28269-7197
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Country | US
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Telephone | 704-605-5989
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Fax | 980-335-0434
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Provider Business Mailing Address
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Address Line | 3020 PROSPERITY CHURCH RD UNIT 178
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City | CHARLOTTE
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State | NC
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Zip | 28269-7197
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Country | US
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Telephone | 704-605-5989
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Fax | 980-335-0434
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. JAY FERNANDO
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Credential | MD
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Telephone | 980-230-6654
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number |
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License Number State |
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