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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