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General NPI Number Information
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NPI Number | 1891676649
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Entity Type | Organization
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Legal Business Name | GRACEFUL PATH YOUTH HOME INC
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Dates
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Enumeration Date | 09/09/2025
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Last Update Date | 09/09/2025
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Provider Practice Location Address
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Address Line | 2003 S YORK RD
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City | GASTONIA
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State | NC
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Zip | 28052-6301
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Country | US
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Telephone | 704-399-7785
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Fax |
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Provider Business Mailing Address
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Address Line | 1532 RUNNING BROOK RD
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City | CHARLOTTE
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State | NC
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Zip | 28214-8666
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Country | US
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Telephone | 414-377-1008
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Fax |
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | LESLIE TAYLOR
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Credential |
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Telephone | 414-377-1008
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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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