Organization
CAROLINA HAVEN PCS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHANIE JACKSON PSS (AGENCY DIRECTOR)
(704) 957-0847
Entity
Organization
Contact information
Practice address
5100 REAGAN DR STE 16, CHARLOTTE, NC 28206-1390
(704) 957-0847
(800) 465-8147
Mailing address
5100 REAGAN DR STE 16, CHARLOTTE, NC 28206-1390
(704) 957-0847
(800) 465-8147
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
—
—
253Z00000X
In Home Supportive Care Agency
Primary
—
—
376K00000X
Nurse's Aide
—
—
Other
Enumeration date
11/12/2019
Last updated
11/12/2019
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