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General NPI Number Information
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NPI Number | 1508246331
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Entity Type | Organization
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Legal Business Name | MALLARD CREEK LEARNING CENTER
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Dates
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Enumeration Date | 06/06/2015
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Last Update Date | 06/06/2015
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Provider Practice Location Address
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Address Line | 8136 BROWNE RD
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City | CHARLOTTE
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State | NC
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Zip | 28269-1101
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Country | US
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Telephone | 704-533-2870
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Fax | 704-948-2047
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Provider Business Mailing Address
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Address Line | 8136 BROWNE RD
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City | CHARLOTTE
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State | NC
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Zip | 28269-1101
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Country | US
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Telephone | 704-533-2870
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. JACQUELINE DENISE WILLIAMS
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Credential |
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Telephone | 704-533-2870
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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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 | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 253J00000X
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Taxonomy Name | Foster Care Agency
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 60002874
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License Number State | NC
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