MEDICARE: THACH FAMILY 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
1	372600000X	Adult Companion
2	376K00000X	Nurse's Aide

General Provider Information

NPI Number	:	1104759281
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THACH FAMILY LLC

Provider Business Mailing Address
First Line	:	1413 ANDOVER RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28211-1809
Country	:	US
Telephone Number	:	704-618-0431
Fax Number	:

Provider Business Practice Location Address
First Line	:	1413 ANDOVER RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28211-1809
Country	:	US
Telephone Number	:	704-618-0431
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. WILLIAM THACH
Credential	:	CDP
Telephone Number	:	704-467-3607

Provider Enumeration Date	:	06/08/2026
Last Update Date	:	06/08/2026

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Directions to “THACH FAMILY LLC ” Practice Location

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