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Organization
YOUTH ADULT CARE MANAGEMENT
Active
Organization
YOUTH ADULT CARE MANAGEMENT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHON BLACK (DIRECTOR)
(704) 933-3505
Entity
Organization
Contact information
Practice address
730 JACK ST, KANNAPOLIS, NC 28081-9573
(704) 933-3505
Mailing address
PO BOX 1013, CONCORD, NC 28026-1013
(704) 933-3505
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
MHL-080-121
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
015WC
BCBS
NC
05
—
6603205
—
NC
Enumeration date
03/15/2007
Last updated
08/01/2007
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