Basic Information
| Provider Information | |||||||||
| NPI: | 1992738009 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HCC - HEALTHCARE OF CHARLOTTE, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ELIZABETH PLACE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 925 N POINT PKWY | ||||||||
| Address2: | SUITE 440 | ||||||||
| City: | ALPHARETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300055210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7706190866 | ||||||||
| FaxNumber: | 7708702892 | ||||||||
| Practice Location | |||||||||
| Address1: | 333 HAWTHORNE LN | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282042433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7043721270 | ||||||||
| FaxNumber: | 7043772059 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | ANSTIS | ||||||||
| AuthorizedOfficialFirstName: | LOUANN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRIVACY OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 7706190866 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | NH0426 | NC | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 3465013 | 05 | NC | MEDICAID |