# GHA AUTISM SUPPORTS

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- **Entity:** Organization
- **Status:** Active
- **Other names:** A. Jack Wall Group Home
- **Organization subpart:** No

## Provider details

- **NPI number:** 1689749889
- **Authorized official:** MRS. DAWN HARWOOD ALLEN (CEO)
- **Authorized official phone:** (704) 982-9600

## Contact information

- **Practice address:** 1213 MOSS SPRINGS ROAD, ALBEMARLE, NC 28001-7810
- **Practice address phone:** (704) 982-9600
- **Practice address fax:** (704) 982-8155
- **Mailing address:** PO BOX 2487, ALBEMARLE, NC 28002-2487
- **Mailing address phone:** (704) 982-9600
- **Mailing address fax:** (704) 982-8155

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 315P00000X | Intellectual Disabilities Intermediate Care Facility | MHL084017 | NC | — |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | MHL084017 | NC | Yes |
| 323P00000X | Psychiatric Residential Treatment Facility | MHL084017 | NC | — |

## Other

- **Enumeration date:** 11/22/2006
- **Last updated:** 07/15/2015