# BELLFLOWER LANE

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

## Provider details

- **NPI number:** 1710056742
- **Authorized official:** MS. CLARISSA HENRY BA QP QSAPP (DIRECTOR BUSINESS DEVELOPMENT)
- **Authorized official phone:** (704) 566-6134

## Contact information

- **Practice address:** 3124 MILTON RD, SUITE 231, CHARLOTTE, NC 28215-5008
- **Practice address phone:** (704) 566-6134
- **Practice address fax:** (704) 566-6136
- **Mailing address:** PO BOX 480794, CHARLOTTE, NC 28269-5323
- **Mailing address phone:** (704) 566-6134
- **Mailing address fax:** (704) 566-6136

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | MHL-060-575 | NC | Yes |

## Other

- **Enumeration date:** 11/06/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 6603949 | — | NC |