1538241351 NPI number — MECKLENBURG COUNTY AREA MENTAL HEALTH AUTHORITY

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538241351 NPI number — MECKLENBURG COUNTY AREA MENTAL HEALTH AUTHORITY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MECKLENBURG COUNTY AREA MENTAL HEALTH AUTHORITY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ADULT CASE MANAGEMENT
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538241351
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
429 BILLINGSLEY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28211-1007
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-336-2023
Provider Business Mailing Address Fax Number:
704-336-4383

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3430 WHEATLEY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28205-7654
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-336-2227
Provider Business Practice Location Address Fax Number:
704-353-0390
Provider Enumeration Date:
10/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CROCKETT
Authorized Official First Name:
GRAYCE
Authorized Official Middle Name:
Authorized Official Title or Position:
AREA DIRECTOR
Authorized Official Telephone Number:
704-336-8638

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8300877B , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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