# YOUTH ADULT CARE MANAGEMENT

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

## Provider details

- **NPI number:** 1639203326
- **Authorized official:** CHON BLACK (DIRECTOR)
- **Authorized official phone:** (704) 933-3505

## Contact information

- **Practice address:** 491 LIBERTY DRIVE, CONCORD, NC 28025-6318
- **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 |
| --- | --- | --- | --- | --- |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | MHL-013-080 | NC | Yes |

## Other

- **Enumeration date:** 03/15/2007
- **Last updated:** 08/01/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 015WC | BCBS | NC |
| 05 | — | 6603206 | — | NC |