Healthcare Provider Details

I. General information

NPI: 1891841524
Provider Name (Legal Business Name): COMMUNITY TREATMENT ALTERNATIVES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 06/30/2021
Certification Date: 06/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2005 BREEZEWOOD DR
CHARLOTTE NC
28262-1423
US

IV. Provider business mailing address

PO BOX 215
MATTHEWS NC
28106-0215
US

V. Phone/Fax

Practice location:
  • Phone: 704-323-9266
  • Fax:
Mailing address:
  • Phone: 704-323-9266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number060-739
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License NumberMHL#060-739
License Number StateNC

VIII. Authorized Official

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