Organization
2ND II NONE FOUNDATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JO ANN HARRIS (CEO)
(704) 780-4608
Entity
Organization
Contact information
Practice address
5312 BELLFLOWER LN, CHARLOTTE, NC 28227-8103
(704) 537-7115
Mailing address
PO BOX 481972, CHARLOTTE, NC 28269-5331
(704) 566-6134
(704) 566-6136
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
MHL-060-575
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6603949
—
NC
Enumeration date
01/05/2007
Last updated
06/25/2008
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