Black Wolf Health North Charlotte, LLC

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

BLACK WOLF HEALTH NORTH CHARLOTTE, LLC

Practice address

400 McGill Ave NW
Suite 30
Concord, NC 28027-6115

Phone

(704) 721-7827

NPI assigned

Sep 4, 2013

Organization subpart

No

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

Authorized official

Name

Mr. Kedrick L Smith

Title

General Manager

Phone

(704) 721-7827

Specialties & licenses 2

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1378252800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1378252800000",
    "number": "1528493962",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 MCGILL AVE NW",
            "address_2": "SUITE 30",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280276115",
            "telephone_number": "704-721-7827"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 MCGILL AVE NW",
            "address_2": "SUITE 30",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280276115",
            "telephone_number": "704-721-7827"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLACK WOLF HEALTH NORTH CHARLOTTE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-04",
        "last_updated": "2013-09-04",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "KEDRICK",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "GENERAL MANAGER",
        "authorized_official_telephone_number": "704-721-7827",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "251J00000X",
            "taxonomy_group": "",
            "desc": "Nursing Care",
            "state": "NC",
            "license": "HC4099",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "THE JOINT COMMISSION",
            "identifier": "513675",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NC-DHSR",
            "identifier": "HC4099",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Candace Bishop, PA-C
• Kazandra Bishop, LMFTA
• Heather Lynn Bixby
• Ebony Bizzell
• BJ'S Wholesale Club Inc.
• David Black, ACNP
• Elizabeth Black, NP
• Marisa Black
• Megan Nicole Black
• Bradley Blackburn, LCMHC, NCC

• Home Health Agency in Concord, NC
• Providers in Concord, NC by specialty
• Home Health Agency in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2013; 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.