Organization
BETTY ANN CLARK
Active
Other names
B.A.C.'s Place
Organization subpart
No
Provider details
NPI number
Authorized official
BETTY ANN CLARK (EXECUTIVE DIRECTOR)
70453231071
Entity
Organization
Contact information
Practice address
9709 AVENSONG CROSSING DR, CHARLOTTE, NC 28215-8078
(704) 532-1071
Mailing address
9709 AVENSONG CROSSING DR, CHARLOTTE, NC 28215-8078
(704) 532-1071
Taxonomy
Speciality
Code
Description
License number
State
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
Primary
60001581
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3409246
—
NC
Enumeration date
01/30/2007
Last updated
08/22/2020
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