NPIMap

Organization Active NPI

Autism Services of Mecklenburg County, Inc.

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Charlotte, NC
National Provider Identifier
1578815940
Registry record updated Oct 10, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X
License
060-350 Issued in NC
Legal business name
AUTISM SERVICES OF MECKLENBURG COUNTY, INC.
Practice address
5300 Kelly St
Charlotte, NC 28205-7912
Phone
(704) 531-1875
NPI assigned
Oct 10, 2012
Last updated
Oct 10, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2012

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

Authorized official

Name
Mr. Jack Marcellous Phillips Jr., MA
Title
Executive Director/Ceo
Phone
(704) 392-9220

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X 060-350 NC Primary

Addresses

Primary practice location

5300 Kelly St
Charlotte, NC 28205-7912

Mailing address

2211 Executive St
Suite a
Charlotte, NC 28208-3661
Phone (704) 392-9220

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

NPI Registry JSON

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

{
    "created_epoch": "1349827200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1349827200000",
    "number": "1578815940",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2211 EXECUTIVE ST",
            "address_2": "SUITE A",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282083661",
            "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": "5300 KELLY ST",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282057912",
            "telephone_number": "704-531-1875"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AUTISM SERVICES OF MECKLENBURG COUNTY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-10",
        "last_updated": "2012-10-10",
        "status": "A",
        "authorized_official_last_name": "PHILLIPS",
        "authorized_official_first_name": "JACK",
        "authorized_official_middle_name": "MARCELLOUS",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR/CEO",
        "authorized_official_telephone_number": "704-392-9220",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "MA"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NC",
            "license": "060-350",
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Oct 10, 2012; 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.