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Organization Active NPI

Gha Autism Supports

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Albemarle, NC
National Provider Identifier
1689749889
Registry record updated Jul 15, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X
License
MHL084017 Issued in NC
Legal business name
GHA AUTISM SUPPORTS
Doing business as
A. Jack Wall Group Home
Practice address
1213 Moss Springs Road
Albemarle, NC 28001-7810
Phone
(704) 982-9600
Fax
(704) 982-8155
NPI assigned
Nov 22, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2015

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

Authorized official

Name
Mrs. Dawn Harwood Allen
Title
Ceo
Phone
(704) 982-9600

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X MHL084017 NC
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X MHL084017 NC Primary
Psychiatric Residential Treatment Facility 323P00000X MHL084017 NC

Addresses

Primary practice location

1213 Moss Springs Road
Albemarle, NC 28001-7810

Mailing address

PO Box 2487
Albemarle, NC 28002-2487
Phone (704) 982-9600

Other identifiers 1

IdentifierTypeStateIssuer
3406165MedicaidNC

Other names 1

  • A. Jack Wall Group Home Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

Intermediate care facility for individuals with intellectual disabilities certification: CCN 34G164

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
A JACK WALL GROUP HOME
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Nov 6, 1990
Last certification
Feb 10, 2026
Beds
6
Ownership / control type
Private (non-profit)
Most recent change of ownership
Jan 15, 2019
Facility address
1213 Moss Springs Road
Albemarle, NC 28001

National Provider Directory

National Provider Directory
Tax ID family
Gha Autism Supports31 organizations share this tax ID, including this one

Other organizations with this tax ID 30

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

View all 30

NPI Registry JSON

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

{
    "created_epoch": "1164153600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1436918400000",
    "number": "1689749889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2487",
            "city": "ALBEMARLE",
            "state": "NC",
            "postal_code": "280022487",
            "telephone_number": "704-982-9600",
            "fax_number": "704-982-8155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1213 MOSS SPRINGS ROAD",
            "city": "ALBEMARLE",
            "state": "NC",
            "postal_code": "280017810",
            "telephone_number": "704-982-9600",
            "fax_number": "704-982-8155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GHA AUTISM SUPPORTS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-22",
        "last_updated": "2015-07-15",
        "status": "A",
        "authorized_official_last_name": "ALLEN",
        "authorized_official_first_name": "DAWN",
        "authorized_official_middle_name": "HARWOOD",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "704-982-9600",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "NC",
            "license": "MHL084017",
            "primary": false
        },
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NC",
            "license": "MHL084017",
            "primary": true
        },
        {
            "code": "323P00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Residential Treatment Facility",
            "state": "NC",
            "license": "MHL084017",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3406165",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "A. Jack Wall Group Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Albemarle, NC

Sources for this page

Verify at the official NPI Registry.