Executive Healthcare Services

Primary specialty

Nursing Care AgencyTaxonomy code 251J00000X

License

HC4747 Issued in NC

Legal business name

EXECUTIVE HEALTHCARE SERVICES

Practice address

10710 Old Bridge LN
Charlotte, NC 28269-8159

Phone

(704) 780-3613

Fax

(704) 593-6695

NPI assigned

Apr 25, 2015

Organization subpart

No

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

Authorized official

Name

Trishonda Shackleford, RN

Title

Owner/Administrator

Phone

(704) 780-3613

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1429920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1438646400000",
    "number": "1962899161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10710 OLD BRIDGE LN",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282698159",
            "telephone_number": "704-780-3613",
            "fax_number": "704-593-6695"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10710 OLD BRIDGE LN",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282698159",
            "telephone_number": "704-780-3613",
            "fax_number": "704-593-6695"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXECUTIVE HEALTHCARE SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-25",
        "last_updated": "2015-08-04",
        "status": "A",
        "authorized_official_last_name": "SHACKLEFORD",
        "authorized_official_first_name": "TRISHONDA",
        "authorized_official_title_or_position": "OWNER/ADMINISTRATOR",
        "authorized_official_telephone_number": "704-780-3613",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "251J00000X",
            "taxonomy_group": "",
            "desc": "Nursing Care",
            "state": "NC",
            "license": "HC4747",
            "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 Aug 4, 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.