Healthcare Provider Details

I. General information

NPI: 1114001153
Provider Name (Legal Business Name): COMMUNITY BASED ALTERNATIVES FOR YOUTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 HICKORY CREEK DR
GASTONIA NC
28052-9141
US

IV. Provider business mailing address

PO BOX 4003
GASTONIA NC
28054-0020
US

V. Phone/Fax

Practice location:
  • Phone: 704-865-3525
  • Fax: 704-865-3520
Mailing address:
  • Phone: 704-865-3525
  • Fax: 704-865-3520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License NumberMHL-036-200
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License NumberMHL-036-200
License Number StateNC

VIII. Authorized Official

Name: MIKE MCNEAL
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 704-865-3525