Organization
CAROLINA COMMUNITY GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IVORY D BETHEA (DIRECTOR)
(704) 582-1793
Entity
Organization
Contact information
Practice address
2818 QUEEN CITY DR STE E, CHARLOTTE, NC 28208-2736
(704) 582-1793
Mailing address
2905 QUEEN CITY DR STE D, CHARLOTTE, NC 28208-2758
(704) 912-4505
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
—
Other
Enumeration date
06/30/2022
Last updated
05/13/2026
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