MEDICARE: GOLDEN RULE OF CHARLOTTE

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	322D00000X	Emotionally Disturbed Childrens' Residential Treatment Facility	MHL-060-869	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

General Provider Information

NPI Number	:	1497800726
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLDEN RULE OF CHARLOTTE

Provider Business Mailing Address
First Line	:	1535 PEACHTREE RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28216-1607
Country	:	US
Telephone Number	:	704-532-0566
Fax Number	:	704-532-0144

Provider Business Practice Location Address
First Line	:	1535 PEACHTREE RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28216-1607
Country	:	US
Telephone Number	:	704-532-0566
Fax Number	:	704-532-0144

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MRS. HATTIE S. MALONE
Credential	:	L.C.S.W.
Telephone Number	:	704-532-0566

Provider Enumeration Date	:	01/25/2007
Last Update Date	:	08/22/2020

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Directions to “GOLDEN RULE OF CHARLOTTE ” Practice Location

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