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Organization
ROPES
Active
Organization
ROPES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH DARNELL SIMMONS (EXEC DIRECTOR)
(704) 595-3335
Entity
Organization
Contact information
Practice address
207 S BROAD ST STE 7, MOORESVILLE, NC 28115-3500
(704) 595-3335
(704) 870-3259
Mailing address
10721 GLENLUCE AVE, CHARLOTTE, NC 28213-4239
(704) 999-7037
(704) 870-3259
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
—
—
Other
Enumeration date
09/29/2014
Last updated
03/03/2023
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