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
7401 LISA CIR, CHARLOTTE, NC 28215-2868
(704) 537-8188
(704) 536-0074
Mailing address
4530 PARK RD STE 300, CHARLOTTE, NC 28209-3790
(704) 536-6661
(704) 536-0074
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
MHL060-158
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7802274
—
NC
Enumeration date
03/29/2007
Last updated
07/31/2017
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