Organization
HEDGEPETH SUPPORTIVE SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES HEDGEPETH (PRESIDENT)
(704) 323-9704
Entity
Organization
Contact information
Practice address
5509 MONROE RD, CHARLOTTE, NC 28212-5503
(704) 510-2287
Mailing address
PO BOX 470341, CHARLOTTE, NC 28247-0341
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8302574H
—
NC
Enumeration date
11/20/2008
Last updated
09/18/2009
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