Organization
CROWN LEGACY SUPPORTIVE SERVICESLLC
Active
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
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up