Organization
CHILDRENS ADVOCACY NETWORK LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VICKIE MCDUFFIE (REIMBURSEMENT COORD)
(704) 833-0154
Entity
Organization
Contact information
Practice address
526 RUBY LN, GASTONIA, NC 28054-4930
(704) 868-5805
(704) 833-7076
Mailing address
1371 E GARRISON BLVD STE A, GASTONIA, NC 28054-5155
(704) 833-0154
(704) 833-7076
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
MHL-036-285
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6604440
—
NC
05
—
8300013B
—
NC
Enumeration date
02/02/2007
Last updated
03/27/2018
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