Organization
BOONDOCK EXPRESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HASAN A ABDUSHAHID (OWNER)
(980) 229-8303
Entity
Organization
Contact information
Practice address
9927 JEANETTE CIR, CHARLOTTE, NC 28213-2129
(980) 229-8303
Mailing address
9927 JEANETTE CIR, CHARLOTTE, NC 28213-2129
(980) 229-8303
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
106S00000X
Behavior Technician
—
—
171M00000X
Case Manager/Care Coordinator
Primary
—
—
225800000X
Recreation Therapist
—
—
225C00000X
Rehabilitation Counselor
—
—
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
251X00000X
Supports Brokerage Agency
—
—
372500000X
Chore Provider
—
—
372600000X
Adult Companion
—
—
3747P1801X
Personal Care Attendant
—
—
376K00000X
Nurse's Aide
—
—
385HR2050X
Respite Care Camp
—
—
Other
Enumeration date
12/25/2023
Last updated
12/25/2023
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