NPIMap

Organization Active NPI

Youth Adult Care Management

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Kannapolis, NC
National Provider Identifier
1215061007
Registry record updated Aug 1, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X
License
MHL-080-121 Issued in NC
Legal business name
YOUTH ADULT CARE MANAGEMENT
Practice address
730 Jack St
Kannapolis, NC 28081-9573
Phone
(704) 933-3505
NPI assigned
Mar 15, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Chon Black
Title
Director
Phone
(704) 933-3505

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X MHL-080-121 NC Primary

Addresses

Primary practice location

730 Jack St
Kannapolis, NC 28081-9573

Mailing address

PO Box 1013
Concord, NC 28026-1013
Phone (704) 933-3505

Other identifiers 2

IdentifierTypeStateIssuer
015WCOtherNCBCBS
6603205MedicaidNC

National Provider Directory

National Provider Directory
Tax ID family
Youth Adult Care Management16 organizations share this tax ID, including this one

Other organizations with this tax ID 15

Organizations that report the same tax identification number in the National Provider Directory.

View all 15

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173916800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1185926400000",
    "number": "1215061007",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1013",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280261013",
            "telephone_number": "704-933-3505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "730 JACK ST",
            "city": "KANNAPOLIS",
            "state": "NC",
            "postal_code": "280819573",
            "telephone_number": "704-933-3505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "YOUTH ADULT CARE MANAGEMENT",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-15",
        "last_updated": "2007-08-01",
        "status": "A",
        "authorized_official_last_name": "BLACK",
        "authorized_official_first_name": "CHON",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "704-933-3505"
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "NC",
            "license": "MHL-080-121",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "015WC",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6603205",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kannapolis, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.