Organization
INREACH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LORI A GOUGEON (PRESIDENT)
(704) 536-6661
Entity
Organization
Contact information
Practice address
1000 POTTERS BLUFF RD, MONROE, NC 28110-7679
(704) 536-6661
(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
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-090-203
NC DEPARTMENT OF HEALTH AND HUMAN SERVICES DIVISION OF HEALTH SERVICE REGULATION
NC
Enumeration date
03/15/2021
Last updated
03/15/2021
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