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General NPI Number Information
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NPI Number | 1801495700
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Entity Type | Organization
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Legal Business Name | ESSENTIAL HOMES OF THE CAROLINA
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Dates
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Enumeration Date | 10/21/2020
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Last Update Date | 10/21/2020
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Provider Practice Location Address
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Address Line | 512 WEARN CT
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City | CHARLOTTE
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State | NC
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Zip | 28206-2972
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Country | US
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Telephone | 704-492-0633
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Fax |
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Provider Business Mailing Address
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Address Line | 512 WEARN CT
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City | CHARLOTTE
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State | NC
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Zip | 28206-2972
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Country | US
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Telephone | 704-492-0633
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LEE ANTOINE LITTLE
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Credential |
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Telephone | 704-492-0633
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1000X
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Taxonomy Name | Migrant Health Clinic/Center
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License Number |
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License Number State |
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