Organization
COMMUNITY LIVING CONCEPTS OF NC, INC.
Active
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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