Organization
YOUTH ADULT CARE MANAGEMENT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHON BLACK (OFFICIAL DIRECTOR)
(704) 933-3505
Entity
Organization
Contact information
Practice address
1605 OLD EARNHARDT RD, KANNAPOLIS, NC 28083-8025
(704) 933-3505
Mailing address
PO BOX 1013, CONCORD, NC 28026-1013
(704) 933-3505
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
MHL-013-061
NC
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
MHL-013-065
NC
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
MHL-013-111
NC
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
MHL-013-112
NC
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
MHL-013-122
NC
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
MHL-013-123
NC
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
MHL-013-125
NC
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
MHL-013-130
NC
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
MHL-013-131
NC
Other
Enumeration date
03/16/2007
Last updated
08/22/2020
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