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General NPI Number Information
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NPI Number | 1457530057
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Entity Type | Organization
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Legal Business Name | ALZHEIMER'S MEMORY CENTER
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Dates
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Enumeration Date | 10/31/2007
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Last Update Date | 08/28/2025
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Provider Practice Location Address
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Address Line | 10801 MONROE RD STE 100
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City | MATTHEWS
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State | NC
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Zip | 28105-8336
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Country | US
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Telephone | 704-364-4000
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Fax | 704-364-4005
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Provider Business Mailing Address
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Address Line | 7809 SARDIS RD
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City | CHARLOTTE
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State | NC
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Zip | 28270-2757
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Country | US
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Telephone | 704-364-4000
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Fax | 704-364-4005
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Authorized Official
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Title or Position | PRESIDENT
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Name | MOHAMMAD R. BOLOURI
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Credential | MD
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Telephone | 704-364-4000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number | 200400301
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License Number State | NC
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