MEDICARE: BS WAY 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	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility

General Provider Information

NPI Number	:	1306625611
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BS WAY LLC

Provider Business Mailing Address
First Line	:	PO BOX 31323
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28231
Country	:	US
Telephone Number	:	980-417-3190
Fax Number	:

Provider Business Practice Location Address
First Line	:	750 NEWFOUND HOLLOW DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28214-4502
Country	:	US
Telephone Number	:	980-417-3190
Fax Number	:

Authorized Official
Title or Position	:	COUNSELOR
Name	:	KELLY LACHELLE SMITH
Credential	:	MD
Telephone Number	:	562-743-8166

Provider Enumeration Date	:	09/26/2023
Last Update Date	:	06/03/2026

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Directions to “BS WAY LLC ” Practice Location

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