Organization
ALEXANDER YOUTH NETWORK OF LENOIR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CRAIG BASS (PRESIDENT & CEO)
(704) 362-8460
Entity
Organization
Contact information
Practice address
140 TREMONT PARK DR SE, LENOIR, NC 28645-2669
(828) 757-9706
(828) 757-0059
Mailing address
PO BOX 220632, CHARLOTTE, NC 28222-0632
(704) 366-8712
(704) 362-8464
Taxonomy
Speciality
Code
Description
License number
State
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8301183
—
NC
05
—
8301183B
—
NC
05
—
8301183R
—
NC
05
—
8301555
—
NC
05
—
8301555B
—
NC
05
—
89014AV
—
NC
Enumeration date
09/28/2006
Last updated
01/30/2009
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