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NPI Code Detail

MEDICARE: FIRST STEP DIRECT CARE, INC

MEDICARE: FIRST STEP DIRECT CARE, INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1320600000XIntellectual and/or Developmental Disabilities Residential Treatment FacilityMHL060709NC

General Provider Information

NPI Number : 1467592436
Entity Type Code : Organization
Provider Name (Legal Business Name) : FIRST STEP DIRECT CARE, INC
Provider Business Mailing Address
First Line : PO BOX 668683
Second Line :
City : CHARLOTTE
State : NC
Zip : 28266-8683
Country : US
Telephone Number : 704-395-2432
Fax Number : 704-395-2432
Provider Business Practice Location Address
First Line : 320 WINDING CANYON DR
Second Line :
City : CHARLOTTE
State : NC
Zip : 28214-5013
Country : US
Telephone Number : 704-395-2432
Fax Number : 704-395-2432
Authorized Official
Title or Position : ADMINISTRATIVE PROGRAM DIRECTOR
Name : GWENDOLYN LAVERN GRAHAM
Credential :
Telephone Number : 803-280-9263
Provider Enumeration Date : 02/07/2007
Last Update Date : 07/24/2007

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Directions to “FIRST STEP DIRECT CARE, INC ” Practice Location

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