Organization · NPI-2

Davenport Family Services LLC

Intermediate Care Facility, Intellectual Disabilities · Charlotte, NC

NPI number1225810609

StatusActive

Last updated in NPPESOct 19, 2023

Details

NPI: 1225810609
Entity type: Organization (NPI-2)
Legal business name: Davenport Family Services LLC
Organization subpart: No
Enumeration date: Oct 19, 2023
Certification date: Oct 19, 2023
Last updated: Oct 19, 2023

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
315P00000X	Intermediate Care Facility, Intellectual Disabilities	–	–	Yes
101YM0800X	Counselor, Mental Health	–	–
385H00000X	Respite Care	–	–
310500000X	Intermediate Care Facility, Mental Illness	–	–
311ZA0620X	Custodial Care Facility, Adult Care Home	–	–

Practice location

3412 Thistle Bloom Ct
Charlotte, NC 28269-1309

Phone 980-384-8103

Mailing address

3412 Thistle Bloom Ct
Charlotte, NC 28269-1309

Phone 980-384-8103

Authorized official

Jermaine Davenport
Ceo
8282794443

Is something wrong?

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