Provider Demographics
NPI:1285709808
Name:CARL G. MCCRAW JR & CO
Entity type:Organization
Organization Name:CARL G. MCCRAW JR & CO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:G
Authorized Official - Last Name:MCCRAW
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:704-366-7054
Mailing Address - Street 1:3707 LATROBE DR
Mailing Address - Street 2:SUITE 460
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-1164
Mailing Address - Country:US
Mailing Address - Phone:704-366-7054
Mailing Address - Fax:704-365-8181
Practice Address - Street 1:3707 LATROBE DR
Practice Address - Street 2:SUITE 460
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-1164
Practice Address - Country:US
Practice Address - Phone:704-366-7054
Practice Address - Fax:704-365-8181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC0029251E00000X
NCHC0028251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408448Medicaid
NC6600175Medicaid