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NPI Code Detail

MEDICARE: COMPLETE CARE AT CHARLOTTE LLC

MEDICARE: COMPLETE CARE AT CHARLOTTE LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing Facility

General Provider Information

NPI Number : 1104351659
Entity Type Code : Organization
Provider Name (Legal Business Name) : COMPLETE CARE AT CHARLOTTE LLC
Provider Business Mailing Address
First Line : 1 TRUMAN AVE
Second Line :
City : LAKEWOOD
State : NJ
Zip : 08701-5661
Country : US
Telephone Number : 732-966-3091
Fax Number :
Provider Business Practice Location Address
First Line : 2616 E 5TH ST
Second Line :
City : CHARLOTTE
State : NC
Zip : 28204-4343
Country : US
Telephone Number : 707-333-5165
Fax Number :
Authorized Official
Title or Position : MEMBER
Name : SHALOM STEIN
Credential :
Telephone Number : 732-966-3091
Provider Enumeration Date : 04/21/2017
Last Update Date : 04/21/2017

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Directions to “COMPLETE CARE AT CHARLOTTE LLC ” Practice Location

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