Organization
SUMMIT PLACE OF SOUTH PARK
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KRISTI HICKSON ANTHONY RN (REGIONAL VP OF OPERATIONS)
(704) 689-1406
Entity
Organization
Contact information
Practice address
2101 RUNNYMEDE LN, CHARLOTTE, NC 28209-3316
(704) 525-5508
(704) 525-2672
Mailing address
2101 RUNNYMEDE LN, CHARLOTTE, NC 28209-3316
(704) 525-5508
(704) 525-2672
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
HAL-060-096
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7806173
—
NC
Enumeration date
08/07/2009
Last updated
08/07/2009
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