Provizions Care LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

PROVIZIONS CARE LLC

Practice address

597 Love St
Concord, NC 28027

Phone

(704) 963-7552

Fax

(774) 307-2797

NPI assigned

Jan 11, 2024

Organization subpart

No

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

Authorized official

Name

Latasha U ProssNPI 1750961470

Title

Ceo

Phone

(704) 963-7552

Specialties & licenses 4

Addresses

Tax ID family

Provizions Care LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Provizions Care LLC

  • Community/Behavioral Health Agency
  • Charlotte, NC
  • NPI 1528513983
  NPD tax ID

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Latasha Pross

  • Behavior Technician
  • Concord, NC
  • NPI 1750961470
  NPD Authorized official

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

{
    "created_epoch": "1704931200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728950400000",
    "number": "1316718067",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5835 EXECUTIVE CENTER DR STE 101F",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282128901",
            "telephone_number": "704-963-7552",
            "fax_number": "774-307-2797"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "597 LOVE ST",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "28027",
            "telephone_number": "704-963-7552",
            "fax_number": "774-307-2797"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7047 Waterwheel St SW",
            "address_purpose": "LOCATION",
            "city": "Concord",
            "state": "NC",
            "postal_code": "280256746",
            "country_code": "US",
            "telephone_number": "704-963-7552",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "424 Lakewood Ave",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "28208",
            "country_code": "US",
            "telephone_number": "704-963-7552",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PROVIZIONS CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-11",
        "last_updated": "2024-10-15",
        "certification_date": "2024-10-10",
        "status": "A",
        "authorized_official_last_name": "PROSS",
        "authorized_official_first_name": "LATASHA",
        "authorized_official_middle_name": "U",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "704-963-7552"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3104A0625X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Mental Illness",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bradley William Propst, MD
• Jimmy Pross Jr.
• Latasha Pross
• Tonda Vanderburg Proulx, NP
• Providence Medical Clinic, Inc.
• James Clifton Pryor
• Public Health Authority of Cabarrus County
• Publix North Carolina LP
• Heather Caudill Puckett, ANP-C
• Ruth Pulley, LCSW

• Community/Behavioral Health Agency in Concord, NC
• Providers in Concord, NC by specialty
• Community/Behavioral Health Agency in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2024; 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.