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General NPI Number Information
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NPI Number | 1649358433
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Entity Type | Organization
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Legal Business Name | COMMUNITY BASED ALTERNATIVES FOR YOUTH
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 12/18/2008
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Provider Practice Location Address
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Address Line | 815 LIMERICK DRIVE
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City | DALLAS
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State | NC
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Zip | 28034-9420
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Country | US
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Telephone | 704-865-3525
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Fax | 704-865-3520
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Provider Business Mailing Address
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Address Line | PO BOX 4003
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City | GASTONIA
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State | NC
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Zip | 28054-0020
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Country | US
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Telephone | 704-865-3525
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Fax | 704-865-3520
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | MIKE MCNEAL
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Credential |
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Telephone | 704-865-3525
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | MHL-036-220
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License Number State | NC
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Taxonomy #2
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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 | MHL-036-220
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License Number State | NC
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