Autism Services of Mecklenburg County, Inc.
Organization Active NPI Intellectual and/or Developmental Disabilities Residential Treatment Facility · Charlotte, NC
NPI 1578815940 · NPPES record last updated Oct 10, 2012
Key facts
- NPI
- 1578815940
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X
- License
- 060-350 (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
- Organization subpart
- No
Authorized official
- Name
- Mr. Jack Marcellous Phillips Jr., MA
- Title
- Executive Director/Ceo
- Phone
- (704) 392-9220
Corporate family (same tax ID) 8
National Provider Directory
- Tax ID family
- Autism Services of Mecklenburg County Inc
Locations
2211 Executive St
Ste A
Charlotte, NC 28208
Phone (704) 392-9220
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Intellectual and/or Developmental Disabilities Residential Treatment Facility | 320600000X | 060-350 | NC | Yes |
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
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7803089 | Medicaid | NC |
Other providers in Charlotte, NC
- Autism Services of Mecklenburg County, Inc.
- Autism Services of Mecklenburg County, Inc.
- Autism Services of Mecklenburg County, Inc.
- Autism Services of Mecklenburg County, Inc.
- Autism Services of Mecklenburg County, Inc.
- Autism Services of Mecklenburg County, Inc.
- Autism Services of Mecklenburg County, Inc.
- Autism180 LLC
- Omega Rushing Autry
- Autumn Carolina LLC
All providers in Charlotte, NC · Intellectual and/or Developmental Disabilities Residential Treatment Facility in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 10, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.