Organization
THE CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY
Active
Other names
Mercy Horizon Outpatient Services
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GREG GOMBAR (ADMINISTRATOR)
(704) 355-2154
Entity
Organization
Contact information
Practice address
7825 BALLANTYNE COMMONS PKWY, SUITE 110, CHARLOTTE, NC 28277-3174
(704) 446-0391
(704) 348-4057
Mailing address
PO BOX 32861, CHARLOTTE, NC 28232-2861
(704) 512-6438
(704) 512-6485
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
MHL060577
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8300444G
—
NC
05
—
8300444P
—
NC
05
—
8300444Q
—
NC
Enumeration date
01/08/2007
Last updated
01/19/2017
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