The Support Village LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

THE SUPPORT VILLAGE LLC

Practice address

4048 Evelyn Ave
Charlotte, NC 28213-3938

Phone

(980) 240-5713

NPI assigned

Apr 16, 2025

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jerritt Davis

Title

Owner

Phone

(980) 240-5713

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1744761600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1744761600000",
    "number": "1164218368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4111E ROSE LAKE DR # 8215",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282172858",
            "telephone_number": "980-240-5713"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4048 EVELYN AVE",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282133938",
            "telephone_number": "980-240-5713"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE SUPPORT VILLAGE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-04-16",
        "last_updated": "2025-04-16",
        "certification_date": "2025-04-16",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "JERRITT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "980-240-5713"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.