MEDICARE: INREACH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility	MHL060-157	NC
2	251S00000X	Community/Behavioral Health Agency
3	311ZA0620X	Adult Care Home Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MHL-060-157	OTHER	NC	NC DEPARTMENT OF HEALTH AND HUMAN SERVICES
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962521823
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INREACH

Provider Business Mailing Address
First Line	:	4014 MONROE RD STE 170
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28205-0094
Country	:	US
Telephone Number	:	704-536-6661
Fax Number	:	704-536-0074

Provider Business Practice Location Address
First Line	:	4922 GREYWOOD DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28212-4826
Country	:	US
Telephone Number	:	704-563-0105
Fax Number	:	704-536-0074

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	LORI GOUGEON
Credential	:
Telephone Number	:	704-536-6661

Provider Enumeration Date	:	03/29/2007
Last Update Date	:	03/28/2025

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Directions to “INREACH ” Practice Location

Language	Start Address	Practice Location

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