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Organization

COMMUNITY LIVING CONCEPTS OF NC, INC.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. MUHAMMAD SHABAZZ (EXECUTIVE DIRECTOR)
(704) 788-2080
Entity
Organization

Contact information

Practice address
211 SOUTH CENTER ST., SUITE 403, STATESVILLE, NC 28677-5873
(704) 838-0016
(704) 838-0019
Mailing address
440 ACTION DRIVE NW, CONCORD, NC 28027
(704) 788-2080
(704) 788-2088

Taxonomy

Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
NC
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
3409659
NC
05
8301157
NC
05
8301158
NC
05
8301477
NC
Enumeration date
11/21/2006
Last updated
03/09/2017
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