Healthcare Provider Details

I. General information

NPI: 1477695369
Provider Name (Legal Business Name): CABARRUS COUNTY GROUP HOMES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 06/11/2021
Certification Date: 06/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

288 AVIATION DR
CHINA GROVE NC
28023-6661
US

IV. Provider business mailing address

PO BOX 1197
CONCORD NC
28026-1197
US

V. Phone/Fax

Practice location:
  • Phone: 704-855-0004
  • Fax: 704-855-0045
Mailing address:
  • Phone: 704-855-0004
  • Fax: 704-855-0045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberMHL-013-085
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. GINGER POPE
Title or Position: ADMINISTRATOR
Credential:
Phone: 704-855-0004