Organization
CONCRETE ROSES LIFE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHAUKURA MANDISA BROWN (CEO)
(980) 263-0991
Entity
Organization
Contact information
Practice address
5960 FAIRVIEW RD STE 323, CHARLOTTE, NC 28210-3102
(980) 263-0991
Mailing address
2040 RANDOLPH RD STE A, CHARLOTTE, NC 28207-1239
(980) 219-8622
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
251V00000X
Voluntary or Charitable Agency
—
—
261QA0600X
Adult Day Care Clinic/Center
—
—
261QD1600X
Developmental Disabilities Clinic/Center
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
261QP0904X
Federal Public Health Clinic/Center
—
—
261QP0905X
State or Local Public Health Clinic/Center
—
—
261QP2000X
Physical Therapy Clinic/Center
—
—
3245S0500X
Children's Substance Abuse Rehabilitation Facility
—
—
385HR2050X
Respite Care Camp
—
—
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
—
Other
Enumeration date
03/21/2018
Last updated
09/02/2021
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