MEDICARE: GARDENIA SERVICES 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	251B00000X	Case Management Agency
2	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1700659307
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GARDENIA SERVICES LLC

Provider Business Mailing Address
First Line	:	4921 ALBEMARLE RD STE 112
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28205-6455
Country	:	US
Telephone Number	:	704-641-3183
Fax Number	:	704-754-5754

Provider Business Practice Location Address
First Line	:	4921 ALBEMARLE RD STE 112
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28205-6455
Country	:	US
Telephone Number	:	704-641-3183
Fax Number	:	704-754-5754

Authorized Official
Title or Position	:	OWNER/MANAGER
Name	:	DARNITA GENERETTE
Credential	:
Telephone Number	:	704-641-3183

Provider Enumeration Date	:	11/06/2023
Last Update Date	:	01/06/2026

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