Organization
INREACH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LORI GOUGEON (EXECUTIVE DIRECTOR)
(704) 536-6661
Entity
Organization
Contact information
Practice address
1631 FORSYTHIA CIR, CHARLOTTE, NC 28208-1835
(704) 399-4826
(704) 536-0074
Mailing address
4014 MONROE RD STE 170, CHARLOTTE, NC 28205-0094
(704) 536-6661
(704) 536-0074
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
311ZA0620X
Adult Care Home Facility
Primary
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
MHL 060-159
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7802253
—
NC
01
—
MHL-060-159
NC DEPARTMENT OF HEALTH AND HUMAN SERVICES
NC
Enumeration date
03/29/2007
Last updated
03/17/2025
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