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General NPI Number Information
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NPI Number | 1609349430
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Entity Type | Organization
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Legal Business Name | ASPIRED RESIDENTIAL REHABILITATION GROUP
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Dates
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Enumeration Date | 01/04/2019
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Last Update Date | 01/04/2019
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Provider Practice Location Address
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Address Line | 1714 ASTER LN
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City | GASTONIA
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State | NC
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Zip | 28054-8303
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Country | US
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Telephone | 984-221-1140
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Fax | 803-630-0376
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Provider Business Mailing Address
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Address Line | 13906 BALLANTYNE MEADOWS DR
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City | CHARLOTTE
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State | NC
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Zip | 28277-3727
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Country | US
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Telephone | 984-221-1140
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | GERVONIA ROBINSION
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Credential |
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Telephone | 984-221-1140
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number |
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License Number State |
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