Healthcare Provider Details

I. General information

NPI: 1417135120
Provider Name (Legal Business Name): UMAR SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2008
Last Update Date: 09/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 BALTIC ST
GASTONIA NC
28054-2712
US

IV. Provider business mailing address

5350 77 CENTER DR STE 201
CHARLOTTE NC
28217-2783
US

V. Phone/Fax

Practice location:
  • Phone: 704-867-0012
  • Fax: 704-864-8936
Mailing address:
  • Phone: 704-875-1328
  • Fax: 704-875-9276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License NumberMHL-036-082
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberMHL-036-082
License Number StateNULL

VIII. Authorized Official

Name: MARILYN GARNER
Title or Position: CEO AND PRESIDENT
Credential:
Phone: 704-659-7630