MEDICARE: PIEDMONT ADULT LIVING SERVICES, INC.

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	261QA0600X	Adult Day Care Clinic/Center	261QA600X	NC

General Provider Information

NPI Number	:	1639212764
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PIEDMONT ADULT LIVING SERVICES, INC.

Provider Business Mailing Address
First Line	:	1201 SOUTH BLVD
Second Line	:	PO BOX 669385
City	:	CHARLOTTE
State	:	NC
Zip	:	28203-4207
Country	:	US
Telephone Number	:	704-370-0093
Fax Number	:	704-370-0940

Provider Business Practice Location Address
First Line	:	1201 SOUTH BLVD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28203-4207
Country	:	US
Telephone Number	:	704-370-0093
Fax Number	:	704-370-0940

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	BETTYE C. MILLS
Credential	:	BACHLOR IN NURSING,
Telephone Number	:	704-370-0093

Provider Enumeration Date	:	02/15/2007
Last Update Date	:	08/22/2020

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