| Little-gerald Services | |
|
1112 Skyway Dr Monroe NC 28110-3045 | |
| (704) 289-3831 | |
| (844) 272-1223 |
| Full Name | Little-gerald Services |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 1112 Skyway Dr, Monroe, North Carolina |
| Authorized Official Name and Position | Fashenda Lashay Little-gerald (OPERATIONS MANAGER) |
| Authorized Official Contact | 7045772139 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Little-gerald Services 11012 Persimmon Creek Dr Mint Hill NC 28227-6687 Ph: (704) 577-2139 | Little-gerald Services 1112 Skyway Dr Monroe NC 28110-3045 Ph: (704) 289-3831 |
| NPI Number | 1093114670 |
|---|---|
| Provider Enumeration Date | 08/19/2014 |
| Last Update Date | 03/09/2021 |
| Certification Date | 03/09/2021 |
| Medicare PECOS PAC ID | 0143566778 |
|---|---|
| Medicare Enrollment ID | O20190117003494 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093114670 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| 253Z00000X | In Home Supportive Care | (* (Not Available)) | Secondary |
| Provider Name | Tamara L Starr |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619995982 PECOS PAC ID: 5799758926 Enrollment ID: I20040817000118 |
| Provider Name | Shkethia Andrea Young |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1710231055 PECOS PAC ID: 1658636667 Enrollment ID: I20180522001951 |
| Provider Name | Jazmon Womack |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1063933539 PECOS PAC ID: 6305265547 Enrollment ID: I20201007002321 |
| Provider Name | David Carraher |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1619456522 PECOS PAC ID: 0941614721 Enrollment ID: I20210208001041 |
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