Healthcare Provider Details

I. General information

NPI: 1003952227
Provider Name (Legal Business Name): COMMUNITY TREATMENT ALTERNATIVES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 08/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3517 CROSS WINDS RD
CHARLOTTE NC
28227
US

IV. Provider business mailing address

PO BOX 215
MATTHEWS NC
28106-0215
US

V. Phone/Fax

Practice location:
  • Phone: 704-532-5883
  • Fax: 704-563-8477
Mailing address:
  • Phone: 704-323-9266
  • Fax: 704-563-8477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number060-857
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License NumberMHL#060-857
License Number StateNC

VIII. Authorized Official

Name: MRS. REGINA DEPASS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 704-323-9266