4C Company, LLC

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

License

FCL-060-115 Issued in NC

Legal business name

4C COMPANY, LLC

Practice address

3505 Oriole PL
Charlotte, NC 28269-1214

Phone

(704) 394-8968

Fax

(704) 394-8967

NPI assigned

May 15, 2009

Organization subpart

No

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

Authorized official

Name

Mrs. Lisa Wigfall, MSW

Title

Ceo

Phone

(704) 394-8968

Specialties & licenses 1

Addresses

Other identifiers 5

Other names 1

• The Radbourne Manor Doing business as

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

{
    "created_epoch": "1242345600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1317254400000",
    "number": "1366677692",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3552 BEATTIES FORD ROAD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282163742",
            "telephone_number": "704-394-8968",
            "fax_number": "704-394-8967"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3505 ORIOLE PL",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282691214",
            "telephone_number": "704-394-8968",
            "fax_number": "704-394-8967"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "4C COMPANY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-05-15",
        "last_updated": "2011-09-29",
        "status": "A",
        "authorized_official_last_name": "WIGFALL",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "704-394-8968",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MSW"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "NC",
            "license": "FCL-060-115",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7806460",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8301662",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6006138",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6601443",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3408495",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Radbourne Manor",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Adult Care Home Facility in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Adult Care Home Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2011; 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.