Healthcare Provider Details

I. General information

NPI: 1558547513
Provider Name (Legal Business Name): ECHELON CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2008
Last Update Date: 03/13/2024
Certification Date: 03/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4724 CARRIAGE DRIVE CIR
CHARLOTTE NC
28205-4922
US

IV. Provider business mailing address

7209 E WT HARRIS BLVD STE J SUITE 207
CHARLOTTE NC
28227-1004
US

V. Phone/Fax

Practice location:
  • Phone: 704-594-9119
  • Fax: 704-594-9119
Mailing address:
  • Phone: 704-594-9119
  • Fax: 704-594-9119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number6604248
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number6604248
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number StateNC

VIII. Authorized Official

Name: ALEX WRIGHT
Title or Position: PRESIDENT
Credential:
Phone: 704-594-9119