Healthcare Provider Details

I. General information

NPI: 1831767334
Provider Name (Legal Business Name): SIMTAS DEVELOPMENT GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2021
Last Update Date: 02/02/2023
Certification Date: 02/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 AVONDALE RD
LOWELL NC
28098-1714
US

IV. Provider business mailing address

125 REMOUNT RD STE C1-1161
CHARLOTTE NC
28203-6458
US

V. Phone/Fax

Practice location:
  • Phone: 704-612-6600
  • Fax:
Mailing address:
  • Phone: 704-612-6600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
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: SHANTEE SIMMONS
Title or Position: OWNER
Credential:
Phone: 919-807-9355