MEDICARE: TITAN HOLDING GROUP, 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	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1619475308
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TITAN HOLDING GROUP, LLC

Provider Business Mailing Address
First Line	:	4944 PARKWAY PLAZA STE 200
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28217-0000
Country	:	US
Telephone Number	:	704-930-2456
Fax Number	:

Provider Business Practice Location Address
First Line	:	4944 PARKWAY PLAZA STE 200
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28217-0000
Country	:	US
Telephone Number	:	704-930-2456
Fax Number	:

Authorized Official
Title or Position	:	CCO
Name	:	CARL MARTIN NOYES
Credential	:
Telephone Number	:	919-285-1593

Provider Enumeration Date	:	01/27/2018
Last Update Date	:	01/27/2018

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