Organization
ABOVE AND BEYOND ENTERPRISE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LONNIE JAMES TUCKER JR. (CEO)
(704) 734-1040
Entity
Organization
Contact information
Practice address
104 S CARPENTER ST, KINGS MOUNTAIN, NC 28086-3415
(704) 734-1040
(704) 734-1095
Mailing address
PO BOX 682, KINGS MOUNTAIN, NC 28086-0682
(704) 734-1040
(704) 734-1095
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
MHL-023-108
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6603537
—
NC
Enumeration date
12/12/2006
Last updated
08/22/2020
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