# BETTY ANN CLARK

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- **Entity:** Organization
- **Status:** Active
- **Other names:** B.A.C.'s Place
- **Organization subpart:** No

## Provider details

- **NPI number:** 1689710006
- **Authorized official:** BETTY ANN CLARK (EXECUTIVE DIRECTOR)
- **Authorized official phone:** 70453231071

## Contact information

- **Practice address:** 9709 AVENSONG CROSSING DR, CHARLOTTE, NC 28215-8078
- **Practice address phone:** (704) 532-1071
- **Mailing address:** 9709 AVENSONG CROSSING DR, CHARLOTTE, NC 28215-8078
- **Mailing address phone:** (704) 532-1071

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 385HR2060X | Child Intellectual and/or Developmental Disabilities Respite Care | 60001581 | NC | Yes |

## Other

- **Enumeration date:** 01/30/2007
- **Last updated:** 08/22/2020