Provider Demographics
NPI:1124740386
Name:QUEEN CITY COCOA BEANS INC
Entity type:Organization
Organization Name:QUEEN CITY COCOA BEANS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/ OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:DEAN
Authorized Official - Suffix:
Authorized Official - Credentials:MPH, RDN, LDN, IBCLC
Authorized Official - Phone:980-224-3748
Mailing Address - Street 1:10887 GARDEN OAKS LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28273-4845
Mailing Address - Country:US
Mailing Address - Phone:980-224-7489
Mailing Address - Fax:
Practice Address - Street 1:2128 REMOUNT RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28208-5051
Practice Address - Country:US
Practice Address - Phone:980-224-3748
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-14
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health