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General NPI Number Information
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NPI Number | 1841434172
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Entity Type | Organization
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Legal Business Name | LIFE CHALLENGES ADOLESCENT TRAINING & TREATMENT ACADEMY
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Dates
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Enumeration Date | 04/30/2009
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Last Update Date | 04/30/2009
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Provider Practice Location Address
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Address Line | 1127 BETHLEHEM RD
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City | KINGS MOUNTAIN
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State | NC
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Zip | 28086-8280
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Country | US
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Telephone | 704-739-2764
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Fax | 704-734-1107
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Provider Business Mailing Address
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Address Line | 1127 BETHLEHEM RD
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City | KINGS MOUNTAIN
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State | NC
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Zip | 28086-8280
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Country | US
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Telephone | 704-739-2764
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Fax | 704-734-1107
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. OCTAVIA DEVONNE SHANKLE
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Credential |
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Telephone | 704-739-2764
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3245S0500X
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Taxonomy Name | Children's Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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