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Organization
4C COMPANY, LLC
Active
Organization
4C COMPANY, LLC
Active
Other names
The Radbourne Manor
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LISA WIGFALL MSW (CEO)
(704) 394-8968
Entity
Organization
Contact information
Practice address
3505 ORIOLE PL, CHARLOTTE, NC 28269-1214
(704) 394-8968
(704) 394-8967
Mailing address
3552 BEATTIES FORD ROAD, CHARLOTTE, NC 28216-3742
(704) 394-8968
(704) 394-8967
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
FCL-060-115
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3408495
—
NC
05
—
6006138
—
NC
05
—
6601443
—
NC
05
—
7806460
—
NC
05
—
8301662
—
NC
Enumeration date
05/15/2009
Last updated
09/29/2011
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