Organization
EXECUTIVE HEALTHCARE SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRISHONDA SHACKLEFORD RN (OWNER/ADMINISTRATOR)
(704) 780-3613
Entity
Organization
Contact information
Practice address
10710 OLD BRIDGE LN, CHARLOTTE, NC 28269-8159
(704) 780-3613
(704) 593-6695
Mailing address
10710 OLD BRIDGE LN, CHARLOTTE, NC 28269-8159
(704) 780-3613
(704) 593-6695
Taxonomy
Speciality
Code
Description
License number
State
251J00000X
Nursing Care Agency
Primary
HC4747
NC
Other
Enumeration date
04/25/2015
Last updated
08/04/2015
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