Organization · NPI-2

Autism Services Of Mecklenburg County, INC.

Intermediate Care Facility, Intellectual Disabilities · Charlotte, NC

NPI number1043561764
StatusActive
Last updated in NPPESSep 20, 2012

Details

NPI
1043561764
Entity type
Organization (NPI-2)
Legal business name
Autism Services Of Mecklenburg County, INC.
Organization subpart
No
Enumeration date
Sep 20, 2012
Last updated
Sep 20, 2012

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
315P00000X Intermediate Care Facility, Intellectual DisabilitiesMHL-060-231NCYes

Practice location

1123 Ravendale Dr
Charlotte, NC 28216-1526

Phone 704-399-3538

Mailing address

2211 Executive St
Suite A
Charlotte, NC 28208-3661

Phone 704-392-9220 · Fax 704-392-9221

Authorized official

Jack Marcellous Phillips
Executive Director/Ceo
7043929220

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