MEDICARE: MCAULEY CIRCLE

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
1	315P00000X	Intellectual Disabilities Intermediate Care Facility	036-037	NC
2	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	MHL 036-012	NC
3	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	MHL-036-037	NC
4	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility	MHL-036-037	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477632446
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCAULEY CIRCLE

Provider Business Mailing Address
First Line	:	6600 W WILKINSON BLVD
Second Line	:
City	:	BELMONT
State	:	NC
Zip	:	28012-2796
Country	:	US
Telephone Number	:	704-825-4161
Fax Number	:	704-825-0401

Provider Business Practice Location Address
First Line	:	6600 W WILKINSON BLVD
Second Line	:
City	:	BELMONT
State	:	NC
Zip	:	28012-2796
Country	:	US
Telephone Number	:	704-825-4161
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	MRS. REGINA P. MOODY
Credential	:	M.ED
Telephone Number	:	704-825-4161

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	03/17/2018

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Directions to “MCAULEY CIRCLE ” Practice Location

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