Organization
STSDAVISLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHANNON MARIE DAVIS (EXECUTIVE DIRECTOR)
(704) 890-6164
Entity
Organization
Contact information
Practice address
431 AMHURST ST SW, CONCORD, NC 28025-8838
(704) 890-6164
Mailing address
431 AMHURST ST SW, CONCORD, NC 28025-8838
(704) 890-6164
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
02/16/2024
Last updated
05/01/2024
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