Organization
CROSSOVER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
COREY BAKER (OWNER)
(704) 201-6116
Entity
Organization
Contact information
Practice address
9779 MALLARD GLEN DRIVE, CHARLOTTE, NC 28262-1115
(704) 201-6116
Mailing address
9779 MALLARD GLEN DRIVE, CHARLOTTE, NC 28262-1115
(704) 201-6116
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
11/15/2007
Last updated
11/15/2007
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