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General NPI Number Information
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NPI Number | 1962899161
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Entity Type | Organization
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Legal Business Name | EXECUTIVE HEALTHCARE SERVICES
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Dates
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Enumeration Date | 04/25/2015
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Last Update Date | 08/04/2015
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Provider Practice Location Address
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Address Line | 10710 OLD BRIDGE LN
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City | CHARLOTTE
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State | NC
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Zip | 28269-8159
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Country | US
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Telephone | 704-780-3613
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Fax | 704-593-6695
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Provider Business Mailing Address
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Address Line | 10710 OLD BRIDGE LN
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City | CHARLOTTE
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State | NC
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Zip | 28269-8159
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Country | US
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Telephone | 704-780-3613
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Fax | 704-593-6695
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | TRISHONDA SHACKLEFORD
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Credential | RN
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Telephone | 704-780-3613
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | HC4747
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License Number State | NC
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