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General NPI Number Information
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NPI Number | 1912051913
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Entity Type | Organization
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Legal Business Name | MICAH'S MANAGEMENT SERVICES
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 01/28/2009
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Provider Practice Location Address
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Address Line | 1909 J N PEASE PL SUITE 204
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City | CHARLOTTE
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State | NC
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Zip | 28262-4558
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Country | US
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Telephone | 704-712-8454
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Fax | 704-532-4414
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Provider Business Mailing Address
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Address Line | 1909 J N PEASE PL SUITE 204
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City | CHARLOTTE
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State | NC
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Zip | 28262-4558
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Country | US
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Telephone | 704-712-8454
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Fax | 704-532-4414
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Authorized Official
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Title or Position | OWNER
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Name | PAULETTE L WASHINGTON
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Credential |
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Telephone | 704-712-8454
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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 | 251B00000X
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License Number State | NC
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