AUTISM SERVICES OF MECKLENBURG COUNTY, INC. (NPI# 1063764702) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063764702 |
| Entity Type | Organization |
| Organization Name | AUTISM SERVICES OF MECKLENBURG COUNTY, INC. |
| Practice Address |
5917 Rowan Way Charlotte NC 28214 |
| Mailing Address |
2211 Executive St Suite A Charlotte NC 28208-3661 |
| Practice Telephone | 7043915559 |
| Practice Fax Number | 7043915560 |
| Mailing Telephone | 7043929220 |
| Mailing Fax Number | 7043929221 |
| Enumeration Date | 2012-10-04 |
| Last Update Date | 2013-01-10 |
| 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-060-514 | NC | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | 3406022 | 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 |
| 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 |
| 1043561764 | Autism Services of Mecklenburg County, Inc. | Intermediate Care Facility, Mentally Retarded | 1123 Ravendale Dr, Charlotte, NC 28216-1526 | 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 |
5917 ROWAN WAY |
| City | CHARLOTTE |
| State | NC |
| Zip Code | 28214 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104456011 | Regina Williams | Custodial Care Facility | 511 Tansy Drive, Charlotte, NC 28214 | 2020-01-20 |
| 1104473974 | Daquan Ford | Technician | 7011 Hunters Glen Drive, Charlotte, NC 28214 | 2019-08-26 |
| 1457836736 | Miracle Houses, Inc. | Community Based Residential Treatment Facility, Mental Illness | 7827 Kerry Brook Circle, Charlotte, NC 28214 | 2018-10-02 |
| 1912481029 | Charlotte Afriyie | Behavior Technician | 2122 Sonoma Valley Drive, Charlotte, NC 28214 | 2018-09-25 |
| 1588161350 | Future Impression | Counselor | 619 Sullivan Street, Charlotte, NC 28214 | 2018-04-09 |
| 1588072326 | Key Choice Counseling | Community/Behavioral Health | 2909 Berry Creek Rd., Charlotte, NC 28214 | 2014-07-24 |
| 1255751699 | Joyce Patterson Melton | Registered Nurse | 7409 Pawtuckett Rd, Charlotte, NC 28214 | 2014-04-24 |
| 1407271109 | Central Carolina Medical Clinic, Pa | Internal Medicine | 515 Little Rock Road, Charlotte, NC 28214 | 2014-03-04 |
| 1043569460 | Loretta Massey | Social Worker | 2202 Lisa Carole Drive, Charlotte, NC 28214 | 2012-08-30 |
| 1023327129 | Margaret Cynthia Stewart | Speech-Language Pathologist | 1805 Mt Isle Harbor Drive, Charlotte, NC 28214 | 2010-10-07 |
| Find all providers in zip 28214 | ||||
| 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 |
| 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 |
| 1043561764 | Autism Services of Mecklenburg County, Inc. | Intermediate Care Facility, Mentally Retarded | 1123 Ravendale Dr, Charlotte, NC 28216-1526 | 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.