NPIMap

Organization Active NPI

Autism Services of Mecklenburg County, Inc.

  • Mental Illness Intermediate Care Facility
  • Charlotte, NC
National Provider Identifier
1477683308
Registry record updated Sep 13, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Intermediate Care FacilityTaxonomy code 310500000X
License
MHL-060-231 Issued in NC
Legal business name
AUTISM SERVICES OF MECKLENBURG COUNTY, INC.
Practice address
2211-A Executive Street
Charlotte, NC 28208-3655
Phone
(704) 392-9220
Fax
(704) 392-9221
NPI assigned
Mar 7, 2007
Last updated
Sep 13, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2018

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

Authorized official

Name
Marcy Alford
Title
Business Manager
Phone
(704) 392-9220

Specialties & licenses 10

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Intermediate Care Facility 310500000X MHL-060-167 NC
Mental Illness Intermediate Care Facility 310500000X MHL-060-118 NC
Mental Illness Intermediate Care Facility 310500000X MHL-060-514 NC
Mental Illness Intermediate Care Facility 310500000X MHL-060-231 NC Primary
Adult Care Home Facility 311ZA0620X MHL-060-908 NC
Adult Care Home Facility 311ZA0620X MHL-060-468 NC
Adult Care Home Facility 311ZA0620X MHL-060-166 NC
Adult Care Home Facility 311ZA0620X MHL-060-350 NC
Intellectual Disabilities Intermediate Care Facility 315P00000X NU
Community/Behavioral Health Agency 251S00000X NC

Addresses

Primary practice location

2211-A Executive Street
Charlotte, NC 28208-3655

Mailing address

2211-A Executive Street
Charlotte, NC 28208-3655
Phone (704) 392-9220

Other practice location 1

5026 Lansing Dr
Charlotte, NC 28270-6076
Phone (704) 365-4366

Other practice location 2

5300 Kelly St
Charlotte, NC 28205-7912
Phone (704) 531-1875

Other practice location 3

5215 Pinebrook Dr
Charlotte, NC 28208-2437
Phone (704) 399-8969

Other practice location 4

4016 Piney Grove Rd
Charlotte, NC 28212-9012
Phone (704) 399-3538

Other practice location 5

4400 Dalmoor Dr
Charlotte, NC 28212-2157
Phone (704) 567-1531

Other practice location 6

1123 Ravendale Dr
Charlotte, NC 28216-1526
Phone (704) 399-3538

Other practice location 7

5917 Rowan Way
Charlotte, NC 28214-2403
Phone (704) 391-5559

Other practice location 8

4319 Mantle Ct
Charlotte, NC 28205-7243
Phone (704) 567-8082

Other identifiers 9

IdentifierTypeStateIssuer
340609AMedicaidNC
3408804MedicaidNC
341612TMedicaidNC
3406022MedicaidNC
7803089MedicaidNC
3406362MedicaidNC
7802270MedicaidNC
340602BMedicaidNC
7804897MedicaidNC

National Provider Directory

National Provider Directory
Tax ID family
Autism Services of Mecklenburg County Inc9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

Locations

2211 Executive St
Ste A
Charlotte, NC 28208
Phone (704) 392-9220

5917 Rowan Way
Charlotte, NC 28214
Phone (704) 391-5559

NPI Registry JSON

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

{
    "created_epoch": "1173225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1536796800000",
    "number": "1477683308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2211-A EXECUTIVE STREET",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282083655",
            "telephone_number": "704-392-9220",
            "fax_number": "704-392-9221"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2211-A EXECUTIVE STREET",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282083655",
            "telephone_number": "704-392-9220",
            "fax_number": "704-392-9221"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5026 Lansing Dr",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282706076",
            "country_code": "US",
            "telephone_number": "704-365-4366",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5300 Kelly St",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282057912",
            "country_code": "US",
            "telephone_number": "704-531-1875",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5215 Pinebrook Dr",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282082437",
            "country_code": "US",
            "telephone_number": "704-399-8969",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4016 Piney Grove Rd",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282129012",
            "country_code": "US",
            "telephone_number": "704-399-3538",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4400 Dalmoor Dr",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282122157",
            "country_code": "US",
            "telephone_number": "704-567-1531",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1123 Ravendale Dr",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282161526",
            "country_code": "US",
            "telephone_number": "704-399-3538",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5917 Rowan Way",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282142403",
            "country_code": "US",
            "telephone_number": "704-391-5559",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4319 Mantle Ct",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282057243",
            "country_code": "US",
            "telephone_number": "704-567-8082",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "AUTISM SERVICES OF MECKLENBURG COUNTY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-07",
        "last_updated": "2018-09-13",
        "status": "A",
        "authorized_official_last_name": "ALFORD",
        "authorized_official_first_name": "MARCY",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "704-392-9220"
    },
    "taxonomies": [
        {
            "code": "310500000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Mental Illness",
            "state": "NC",
            "license": "MHL-060-167",
            "primary": false
        },
        {
            "code": "310500000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Mental Illness",
            "state": "NC",
            "license": "MHL-060-118",
            "primary": false
        },
        {
            "code": "310500000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Mental Illness",
            "state": "NC",
            "license": "MHL-060-514",
            "primary": false
        },
        {
            "code": "310500000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Mental Illness",
            "state": "NC",
            "license": "MHL-060-231",
            "primary": true
        },
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "NC",
            "license": "MHL-060-908",
            "primary": false
        },
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "NC",
            "license": "MHL-060-468",
            "primary": false
        },
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "NC",
            "license": "MHL-060-166",
            "primary": false
        },
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "NC",
            "license": "MHL-060-350",
            "primary": false
        },
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NC",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "340609A",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3408804",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "341612T",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3406022",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7803089",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3406362",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7802270",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "340602B",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7804897",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2018; 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.