Organization
BLACK WOLF HEALTH NORTH CHARLOTTE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KEDRICK L SMITH (GENERAL MANAGER)
(704) 721-7827
Entity
Organization
Contact information
Practice address
400 MCGILL AVE NW, SUITE 30, CONCORD, NC 28027-6115
(704) 721-7827
Mailing address
400 MCGILL AVE NW, SUITE 30, CONCORD, NC 28027-6115
(704) 721-7827
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
251J00000X
Nursing Care Agency
HC4099
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
513675
THE JOINT COMMISSION
NC
01
—
HC4099
NC-DHSR
NC
Enumeration date
09/04/2013
Last updated
09/04/2013
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