NPI 1043561764

Autism Services of Mecklenburg County, INC.

Organisation Intellectual Disabilities Intermediate Care Facility Charlotte, NC

Practice location

Address: 1123 Ravendale Dr, Charlotte, NC 28216-1526
Phone: (704) 399-3538
Mailing address: 2211 Executive St Suite a, Charlotte, NC 28208-3661

Authorised official

Name: Jack Marcellous Phillips
Title: Executive Director/Ceo
Phone: (704) 392-9220

Registered specialties

Intellectual Disabilities Intermediate Care Facility Primary

Nursing & Custodial Care Facilities Taxonomy 315P00000X Licence MHL-060-231 (NC)

Other Intermediate Care Facility, Intellectual Disabilities providers in North Carolina →

Registry record

NPI: 1043561764
Entity type: Organization
NPI issued: 20 Sep 2012
Record last updated: 20 Sep 2012

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.