Provider Demographics
NPI:1669989554
Name:CAROLINA CENTER FOR RECOVERY
Entity type:Organization
Organization Name:CAROLINA CENTER FOR RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:
Authorized Official - Last Name:GUCCIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-844-6958
Mailing Address - Street 1:7349 STATESVILLE RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-3702
Mailing Address - Country:US
Mailing Address - Phone:704-844-6958
Mailing Address - Fax:704-973-7875
Practice Address - Street 1:7349 STATESVILLE RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-3702
Practice Address - Country:US
Practice Address - Phone:704-844-6958
Practice Address - Fax:704-973-7875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-02
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilityGroup - Single Specialty