Healthcare Provider Details

I. General information

NPI: 1083733927
Provider Name (Legal Business Name): INREACH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 07/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7401 LISA CIR
CHARLOTTE NC
28215-2868
US

IV. Provider business mailing address

4530 PARK RD STE 300
CHARLOTTE NC
28209-3790
US

V. Phone/Fax

Practice location:
  • Phone: 704-537-8188
  • Fax: 704-536-0074
Mailing address:
  • Phone: 704-536-6661
  • Fax: 704-536-0074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License NumberMHL060-158
License Number StateNC

VIII. Authorized Official

Name: LORI GOUGEON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 704-536-6661