# YOUTH ADULT CARE MANAGEMENT

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114051349
- **Authorized official:** CHON BLACK (OFFICIAL DIRECTOR)
- **Authorized official phone:** (704) 933-3505

## Contact information

- **Practice address:** 1605 OLD EARNHARDT RD, KANNAPOLIS, NC 28083-8025
- **Practice address phone:** (704) 933-3505
- **Mailing address:** PO BOX 1013, CONCORD, NC 28026-1013
- **Mailing address phone:** (704) 933-3505

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | MHL-013-061 | NC | — |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | MHL-013-065 | NC | — |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | MHL-013-111 | NC | — |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | MHL-013-112 | NC | — |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | MHL-013-122 | NC | — |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | MHL-013-123 | NC | Yes |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | MHL-013-125 | NC | — |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | MHL-013-130 | NC | — |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | MHL-013-131 | NC | — |

## Other

- **Enumeration date:** 03/16/2007
- **Last updated:** 08/22/2020