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General NPI Number Information
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NPI Number | 1518032267
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Entity Type | Organization
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Legal Business Name | COMMUNITY LIVING CONCEPTS OF NC, INC.
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Dates
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Enumeration Date | 11/21/2006
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Last Update Date | 03/09/2017
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Provider Practice Location Address
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Address Line | 211 SOUTH CENTER ST. SUITE 403
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City | STATESVILLE
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State | NC
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Zip | 28677-5873
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Country | US
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Telephone | 704-838-0016
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Fax | 704-838-0019
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Provider Business Mailing Address
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Address Line | 440 ACTION DRIVE NW
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City | CONCORD
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State | NC
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Zip | 28027
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Country | US
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Telephone | 704-788-2080
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Fax | 704-788-2088
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. MUHAMMAD SHABAZZ
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Credential |
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Telephone | 704-788-2080
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State | NC
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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 | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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