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Organization
GHA AUTISM SUPPORTS
Active
Organization
GHA AUTISM SUPPORTS
Active
Other names
A. Jack Wall Group Home
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DAWN HARWOOD ALLEN (CEO)
(704) 982-9600
Entity
Organization
Contact information
Practice address
1213 MOSS SPRINGS ROAD, ALBEMARLE, NC 28001-7810
(704) 982-9600
(704) 982-8155
Mailing address
PO BOX 2487, ALBEMARLE, NC 28002-2487
(704) 982-9600
(704) 982-8155
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
MHL084017
NC
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
MHL084017
NC
323P00000X
Psychiatric Residential Treatment Facility
MHL084017
NC
Other
Enumeration date
11/22/2006
Last updated
07/15/2015
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