Healthcare Provider Details

I. General information

NPI: 1134211030
Provider Name (Legal Business Name): ALEXANDER YOUTH NETWORK OF LENOIR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 01/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 TREMONT PARK DR SE
LENOIR NC
28645-2669
US

IV. Provider business mailing address

PO BOX 220632
CHARLOTTE NC
28222-0632
US

V. Phone/Fax

Practice location:
  • Phone: 828-757-9706
  • Fax: 828-757-0059
Mailing address:
  • Phone: 704-366-8712
  • Fax: 704-362-8464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. CRAIG BASS
Title or Position: PRESIDENT & CEO
Credential:
Phone: 704-362-8460