Organization
CROWN LEGACY SUPPORTIVE SERVICESLLC
Active
Other names
Bradley-Reid Corporation
Organization subpart
No
Provider details
NPI number
Authorized official
SANDRA BRADLEY REID MHA,MBA (CHIEF EXECUTIVE OFFICER)
(704) 333-5686
Entity
Organization
Contact information
Practice address
715 E 5TH ST, SUITE 216, CHARLOTTE, NC 28202-3001
(704) 333-5686
(704) 376-1931
Mailing address
715 E 5TH ST, SUITE 216, CHARLOTTE, NC 28202-3001
(704) 333-5686
(704) 376-1931
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
252Y00000X
Early Intervention Provider Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
347C00000X
Private Vehicle
—
—
385H00000X
Respite Care
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6008557
—
NC
Enumeration date
04/17/2015
Last updated
04/17/2015
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