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1518032267 NPI number — COMMUNITY LIVING CONCEPTS OF NC, INC.

NPI Number: 1518032267
Health Care Provider/Practitioner: COMMUNITY LIVING CONCEPTS OF NC, INC.

Information about “1518032267” NPI (COMMUNITY LIVING CONCEPTS OF NC, INC.) exists in 1518032267 in HTML format HTML  |  1518032267 in plain Text format TXT  |  1518032267 in PDF (Portable Document Format) PDF  |  1518032267 in an XML format XML  formats.

NPI Number : 1518032267 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1518032267",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "COMMUNITY LIVING CONCEPTS OF NC, INC.",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "440 ACTION DRIVE NW",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CONCORD",
    "MailingAddressStateName": "NC",
    "MailingAddressPostalCode": "28027",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "704-788-2080",
    "MailingAddressFaxNumber": "704-788-2088",
    "FirstLinePracticeLocationAddress": "211 SOUTH CENTER ST.",
    "SecondLinePracticeLocationAddress": "SUITE 403",
    "PracticeLocationAddressCityName": "STATESVILLE",
    "PracticeLocationAddressStateName": "NC",
    "PracticeLocationAddressPostalCode": "28677-5873",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "704-838-0016",
    "PracticeLocationAddressFaxNumber": "704-838-0019",
    "EnumerationDate": "11/21/2006",
    "LastUpdateDate": "03/09/2017",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "SHABAZZ",
    "AuthorizedOfficialFirstName": "MUHAMMAD",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "EXECUTIVE DIRECTOR",
    "AuthorizedOfficialNamePrefix": "MR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "704-788-2080",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "320900000X",
          "TaxonomyName": "Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility",
          "LicenseNumber": null,
          "LicenseNumberStateCode": "NC",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "251C00000X",
          "TaxonomyName": "Developmentally Disabled Services Day Training Agency",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "320900000X",
          "TaxonomyName": "Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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