Organization
ENTERPRO STC SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SHANDA G KNOX BS (PRESIDENT)
(704) 852-3053
Entity
Organization
Contact information
Practice address
1554 UNION RD STE B, GASTONIA, NC 28054-5581
(704) 852-3053
(704) 852-3756
Mailing address
1554 UNION RD STE B, GASTONIA, NC 28054-5581
(704) 852-3053
(704) 852-3756
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
C001183
NC
253Z00000X
In Home Supportive Care Agency
C001183
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6006204
—
NC
Enumeration date
06/01/2009
Last updated
06/08/2009
Update your record
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