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Organization
PROVIZIONS CARE LLC
Active
Organization
PROVIZIONS CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LATASHA U PROSS (CEO)
(704) 963-7552
Entity
Organization
Contact information
Practice address
597 LOVE ST, CONCORD, NC 28027
(704) 963-7552
(774) 307-2797
Mailing address
5835 EXECUTIVE CENTER DR STE 101F, CHARLOTTE, NC 28212-8901
(704) 963-7552
(774) 307-2797
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
253Z00000X
In Home Supportive Care Agency
—
—
3104A0625X
Assisted Living Facility (Mental Illness)
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
—
Other
Enumeration date
01/11/2024
Last updated
10/15/2024
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