Organization · NPI-2

Autism Services Of Mecklenburg County, INC.

Intermediate Care Facility, Intellectual Disabilities · Charlotte, NC

NPI number1063764702
StatusActive
Last updated in NPPESJan 10, 2013

Details

NPI
1063764702
Entity type
Organization (NPI-2)
Legal business name
Autism Services Of Mecklenburg County, INC.
Organization subpart
No
Enumeration date
Oct 4, 2012
Last updated
Jan 10, 2013

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
315P00000X Intermediate Care Facility, Intellectual DisabilitiesMHL-060-514NCYes

Practice location

5917 Rowan Way
Charlotte, NC 28214

Phone 704-391-5559 · Fax 704-391-5560

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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