AUTISM SERVICES OF MECKLENBURG COUNTY, INC. (NPI# 1043561764) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1043561764 |
| Entity Type | Organization |
| Organization Name | AUTISM SERVICES OF MECKLENBURG COUNTY, INC. |
| Practice Address |
1123 Ravendale Dr Charlotte NC 28216-1526 |
| Mailing Address |
2211 Executive St Suite A Charlotte NC 28208-3661 |
| Practice Telephone | 7043993538 |
| Mailing Telephone | 7043929220 |
| Mailing Fax Number | 7043929221 |
| Enumeration Date | 2012-09-20 |
| Last Update Date | 2012-09-20 |
| Authorized Official Name | MR. JACK MARCELLOUS PHILLIPS JR. (EXECUTIVE DIRECTOR/CEO) |
| Authorized Official Telephone | 7043929220 |
| Authorized Official Credential | MA |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 315P00000X | Intermediate Care Facility, Mentally Retarded | MHL-060-231 | NC | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | 340609A | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881931921 | Autism Services of Mecklenburg County, Inc. | Community/Behavioral Health | 5026 Lansing Dr, Charlotte, NC 28270-6076 | 2013-01-09 |
| 1578815940 | Autism Services of Mecklenburg County, Inc. | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 5300 Kelly St, Charlotte, NC 28205-7912 | 2012-10-10 |
| 1477805745 | Autism Services of Mecklenburg County, Inc. | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 4016 Piney Grove Rd, Charlotte, NC 28212-9012 | 2012-10-10 |
| 1063764702 | Autism Services of Mecklenburg County, Inc. | Intermediate Care Facility, Mentally Retarded | 5917 Rowan Way, Charlotte, NC 28214 | 2012-10-04 |
| 1972854693 | Autism Services of Mecklenburg County, Inc. | Intermediate Care Facility, Mentally Retarded | 4319 Mantle Ct, Charlotte, NC 28205-7243 | 2012-09-20 |
| 1093066714 | Autism Services of Mecklenburg County, Inc. | Intermediate Care Facility, Mentally Retarded | 4400 Dalmoor Dr, Charlotte, NC 28212-2157 | 2012-09-20 |
| 1477683308 | Autism Services of Mecklenburg County, Inc. | Custodial Care Facility | 2211-a Executive Street, Charlotte, NC 28208-3655 | 2007-03-07 |
| Street Address |
1123 RAVENDALE DR |
| City | CHARLOTTE |
| State | NC |
| Zip Code | 28216-1526 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942837331 | Transit Consortium of South Carolina, LLC | Non-emergency Medical Transport (VAN) | 5025 Roundstone Way, Suite 103, Charlotte, NC 28216 | 2020-03-25 |
| 1811538796 | Strengthening Families Within Communities LLC | Community/Behavioral Health | 4135 Bryan Furr Drive, Charlotte, NC 28216 | 2019-10-02 |
| 1841705159 | Karen Sue Rhea | Registered Nurse | 4004 Nicole Eileen Lane, Charlotte, ND 28216 | 2017-12-08 |
| 1992225890 | Be Free Counseling, Pllc | Social Worker | 7800 Bridle Court, Charlotte, NC 28216 | 2017-06-21 |
| 1013466416 | Roha Solutions, Inc | Community Based Residential Treatment Facility, Mental Illness | 1529 Jennings St, Charlotte, NC 28216 | 2016-09-26 |
| 1336595826 | North Carolina Neurodiagnostics, LLC | Clinic/Center | 10130 Perimeter Pwky, Ste. 200, Office 250, Charlotte, NC 28216 | 2016-05-13 |
| 1346600699 | Elizabeth Ayodele Agiri | Registered Nurse | 9404 Perimeter Station Dr, Apt. 108, Charlotte, NC 28216 | 2016-02-29 |
| 1922479179 | Prashant Patel | Pharmacist | 9820 Callibridge Court, Charlotte, NC 28216 | 2015-10-14 |
| 1205226685 | Sarah Baker | Social Worker | 10506 Grobie Way Apt 104, Charlotte, NC 28216 | 2015-01-23 |
| 1578967089 | The Moon Home | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 4548 Hyperion Court, Charlotte, NC 28216 | 2014-10-13 |
| Find all providers in zip 28216 | ||||
| Taxonomy Code | 315P00000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Intermediate Care Facility, Mentally Retarded |
| (1) A public institution for care of the mentally retarded or people with related conditions. (2) An institution giving active treatment to mentally retarded or developmentally disabled persons or persons with related conditions. The primary purpose of the institution is to provide health or rehabilitative services to such individuals. |
| Notes: Sources: (1) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, IL: 1994, p. 403 (2) Paraphrased from Code of Federal Regulations #42, Public Health, Section 440.150(c). |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811517774 | Educare Community Living Corporation-north Carolina | Intermediate Care Facility, Mentally Retarded | 834 Tyvola Rd Ste 116, Charlotte, NC 28217-3542 | 2020-04-21 |
| 1861822314 | Voca Corporation of North Carolina | Intermediate Care Facility, Mentally Retarded | 4109 Enoch Dr, Charlotte, NC 28269-2578 | 2013-11-20 |
| 1770827552 | Educare Community Living Corporation - North Carolina | Intermediate Care Facility, Mentally Retarded | 8205 Browne Rd., Charlotte, NC 28217 | 2012-11-19 |
| 1063764702 | Autism Services of Mecklenburg County, Inc. | Intermediate Care Facility, Mentally Retarded | 5917 Rowan Way, Charlotte, NC 28214 | 2012-10-04 |
| 1972854693 | Autism Services of Mecklenburg County, Inc. | Intermediate Care Facility, Mentally Retarded | 4319 Mantle Ct, Charlotte, NC 28205-7243 | 2012-09-20 |
| 1093066714 | Autism Services of Mecklenburg County, Inc. | Intermediate Care Facility, Mentally Retarded | 4400 Dalmoor Dr, Charlotte, NC 28212-2157 | 2012-09-20 |
| 1255451233 | Voca Corporation of North Carolina, Inc. | Intermediate Care Facility, Mentally Retarded | 5416 Oak Dr, Charlotte, NC 28216-2645 | 2007-03-31 |
| 1972623957 | Voca Corporation of North Carolina, Inc. | Intermediate Care Facility, Mentally Retarded | 1615 Purser Dr, Charlotte, NC 28215-2934 | 2007-03-31 |
| 1598885584 | Voca Corporation of North Carolina, Inc. | Intermediate Care Facility, Mentally Retarded | 2103 Wilson Ave, Charlotte, NC 28208-4655 | 2007-03-31 |
| 1902926983 | Voca Corporation of North Carolina, Inc. | Intermediate Care Facility, Mentally Retarded | 3017 Simpson Dr, Charlotte, NC 28205-2562 | 2007-03-31 |
| Find all providers in CHARLOTTE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.