Betty Ann Clark

Primary specialty

Child Intellectual and/or Developmental Disabilities Respite CareTaxonomy code 385HR2060X

License

60001581 Issued in NC

Legal business name

BETTY ANN CLARK

Doing business as

B.A.C.'s Place

Practice address

9709 Avensong Crossing Dr
Charlotte, NC 28215-8078

Phone

(704) 532-1071

NPI assigned

Jan 30, 2007

Organization subpart

No

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

Authorized official

Name

Betty Ann Clark

Title

Executive Director

Phone

70453231071

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• B.A.C.'s Place Doing business as

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

{
    "created_epoch": "1170115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1689710006",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9709 AVENSONG CROSSING DR",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282158078",
            "telephone_number": "704-532-1071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9709 AVENSONG CROSSING DR",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282158078",
            "telephone_number": "704-532-1071"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BETTY ANN CLARK",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-30",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "BETTY ANN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "70453231071"
    },
    "taxonomies": [
        {
            "code": "385HR2060X",
            "taxonomy_group": "",
            "desc": "Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child",
            "state": "NC",
            "license": "60001581",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3409246",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "B.A.C.'s Place",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Child Intellectual and/or Developmental Disabilities Respite Care in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Child Intellectual and/or Developmental Disabilities Respite Care in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.