# MY BROTHERS HOUSE INC.

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

## Provider details

- **NPI number:** 1114069119
- **Authorized official:** MR. RICHARD TAYLOR (CEO)
- **Authorized official phone:** (704) 532-4770

## Contact information

- **Practice address:** 4822 ALBEMARLE RD STE 105, CHARLOTTE, NC 28205-6612
- **Practice address phone:** (704) 532-4770
- **Practice address fax:** (704) 532-4774
- **Mailing address:** 4822 ALBEMARLE RD, SUITE 105, CHARLOTTE, NC 28205-6668
- **Mailing address phone:** (704) 532-4770

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251S00000X | Community/Behavioral Health Agency | — | — | — |
| 320800000X | Mental Illness Community Based Residential Treatment Facility | — | — | — |
| 323P00000X | Psychiatric Residential Treatment Facility | 060-467 | NC | — |
| 323P00000X | Psychiatric Residential Treatment Facility | 060-538 | NC | — |
| 323P00000X | Psychiatric Residential Treatment Facility | 060-757 | NC | — |
| 323P00000X | Psychiatric Residential Treatment Facility | 092-519 | NC | Yes |

## Other

- **Enumeration date:** 02/13/2007
- **Last updated:** 07/03/2019