<Unavail>

LBN: Crown Legacy Supportive Servicesllc
<Unavail> is an health care organization with primary practice located at 715 E 5Th St Suite 216, Charlotte NC 28202-3001. The organization recently has 7 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Clinical, Agencies / Case Management, Agencies / Community/Behavioral Health, Agencies / Early Intervention Provider Agency, Agencies / In Home Supportive Care, Transportation Services / Private Vehicle, Respite Care Facility / Respite Care. Behavioral Health & Social Service Providers / Clinical is the primary health care specialty. Crown Legacy Supportive Servicesllc can be contacted via phone (704) 333-5686, or through Reid, Sandra Bradley via phone (704) 333-5686.

Contact Information

Primary practice address
715 E 5Th St Suite 216 Charlotte NC 28202-3001
Phone: (704) 333-5686
Fax: (704) 376-1931
Website:
Map and Directions
Authorized official contact:
Name: Reid, Sandra Bradley MHA,MBA
Phone: (704) 333-5686

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 1041C0700X
Agencies / Case Management 251B00000X
Agencies / Community/Behavioral Health 251S00000X
Agencies / Early Intervention Provider Agency 252Y00000X
Agencies / In Home Supportive Care 253Z00000X
Transportation Services / Private Vehicle 347C00000X
Respite Care Facility / Respite Care 385H00000X

Profile Details

NPI number 1326435314
LBN Legal business name Crown Legacy Supportive Servicesllc
DBA Doing business as <Unavail>
Authorized official Reid, Sandra Bradley MHA,MBA
Entity Organization
Organization subpart 1 No
Enumeration date Apr 17th, 2015
Last updated Apr 17th, 2015 - about 11 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1326435314 NPPES
North Carolina MEDICAID 6008557

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