Crown Legacy Supportive Servicesllc

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

CROWN LEGACY SUPPORTIVE SERVICESLLC

Practice address

715 E 5TH St
Suite 216
Charlotte, NC 28202-3001

Phone

(704) 333-5686

Fax

(704) 376-1931

NPI assigned

Apr 17, 2015

Organization subpart

No

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

Authorized official

Name

Sandra Bradley Reid, MHA,MBA

Title

Chief Executive Officer

Phone

(704) 333-5686

Specialties & licenses 7

Addresses

Other identifiers 1

Other names 1

• Bradley-Reid Corporation Other name

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

{
    "created_epoch": "1429228800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1429228800000",
    "number": "1326435314",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "715 E 5TH ST",
            "address_2": "SUITE 216",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282023001",
            "telephone_number": "704-333-5686",
            "fax_number": "704-376-1931"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "715 E 5TH ST",
            "address_2": "SUITE 216",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282023001",
            "telephone_number": "704-333-5686",
            "fax_number": "704-376-1931"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CROWN LEGACY SUPPORTIVE SERVICESLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-17",
        "last_updated": "2015-04-17",
        "status": "A",
        "authorized_official_last_name": "REID",
        "authorized_official_first_name": "SANDRA",
        "authorized_official_middle_name": "BRADLEY",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "704-333-5686",
        "authorized_official_credential": "MHA,MBA"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "347C00000X",
            "taxonomy_group": "",
            "desc": "Private Vehicle",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "385H00000X",
            "taxonomy_group": "",
            "desc": "Respite Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6008557",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bradley-Reid Corporation",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Clinical Social Worker in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2015; 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.