Organization
GHA AUTISM SUPPORTS
Active
Other names
Marie G. Smith 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
1921 PALMETTO DRIVE, ALBEMARLE, NC 28001-8605
(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
MHL084008
NC
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
MHL084008
NC
323P00000X
Psychiatric Residential Treatment Facility
MHL084061
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3406392
—
NC
Enumeration date
11/21/2006
Last updated
07/15/2015
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