Organization
INREACH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LORI GOUGEON (CEO)
(704) 536-6661
Entity
Organization
Contact information
Practice address
712 FALLS CHURCH RD, CHARLOTTE, NC 28270-2191
(704) 845-0688
(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
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MHL-060-1285
NC DEPARTMENT OF HEALTH AND HUMAN SERVICES
NC
Enumeration date
08/03/2017
Last updated
03/17/2025
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