Gary

NPI 1063747319 - Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities - 320900000X

NPI Details
NPI 1063747319
Enumeration Date 10/05/2009
Last Updated 06/24/2013
Entity Type Healthcare Provider
Active Over 7 years ago
Authorized Information
Name SHANNON SHANNON
Position VICE PRESIDENT OF CLINICAL SERVICES
Phone (704) 825-4161
Fax (704) 825-0401
Practice Location
20 MCAULEY CIRCLE
BELMONT NC, 28012-0710, US
Phone (704) 825-4161
Fax (704) 825-0401
Business Location
6600 W WILKINSON BLVD
BELMONT NC, 28012-2796, US
Phone
Fax
Toxanomy
Taxonomy Code 320900000X
License State North Carolina
License Number MHL-036-012
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According to our database, Gary NPI is 1063747319, taxonomy code is 320900000X and license number is MHL-036-012, license state is located at North Carolina. Gary physically located at 20 Mcauley Circle, Belmont NC, 28012-0710. NPI Number 1033115704 has the healthcare provider type.

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1063747319 NPI number is provided on an as is basis without warranty of any kind. 1063747319 is maintained by the National Plan & Provider Enumeration System. The contents of Gary are for informational purposes only.