Healthcare Provider Details

I. General information

NPI: 1457164691
Provider Name (Legal Business Name): RATLIFF'S HOME, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2025
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1712 AMERIA RD
CHARLOTTE NC
28215-7759
US

IV. Provider business mailing address

1712 AMERIA RD
CHARLOTTE NC
28215-7759
US

V. Phone/Fax

Practice location:
  • Phone: 704-293-3305
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: BRIAN RATLIFF
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 704-293-3305