MEDICARE: MECKLENBURG OPEN DOOR, 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
1	320800000X	Mental Illness Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1669601829
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MECKLENBURG OPEN DOOR, INC.

Provider Business Mailing Address
First Line	:	1515 MOCKINGBIRD LN
Second Line	:	SUITE 1015
City	:	CHARLOTTE
State	:	NC
Zip	:	28209-3236
Country	:	US
Telephone Number	:	704-525-3255
Fax Number	:	704-525-0949

Provider Business Practice Location Address
First Line	:	8936 SHARONBROOK DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28210-5698
Country	:	US
Telephone Number	:	704-552-8210
Fax Number	:	704-552-8210

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	EDWARD G PAYTON
Credential	:
Telephone Number	:	704-525-3255

Provider Enumeration Date	:	07/09/2009
Last Update Date	:	07/09/2009

Similar Medicare Providers

1407294499 — MONARCH
Practice Location Address:

8936 SHARONBROOK DR
CHARLOTTE, NC
28210-5698

Practice Phone: 704-522-8210
Practice Fax: 704-552-8210

1144950387 — MARGARET O ERHABOR APRN
Practice Location Address:

3512 WILKINSON BLVD STE 130
CHARLOTTE, NC
28208-5698

Practice Phone: 980-999-2964
Practice Fax: 877-691-5325

1962637827 — DR. JERELL DIEGO CHUA MPH, D.O.
Practice Location Address:

3512 WILKINSON BLVD STE 130
CHARLOTTE, NC
28208-5698

Practice Phone: 980-999-2964
Practice Fax: 877-691-5325

1831836758 — CENTERWELL SENIOR PRIMARY CARE NC JV PC
Practice Location Address:

3512 WILKINSON BLVD STE 130
CHARLOTTE, NC
28208-5698

Practice Phone: 980-999-2964
Practice Fax: 877-691-5325

1487598397 — NOANT HEALTH MEDICAL GROUP, LLC
Practice Location Address:

6324 FAIRVIEW RD STE 200
CHARLOTTE, NC
28210-3361

Practice Phone: 999-999-9999
Practice Fax:

1497199921 — HEALTHY PHIT PHYSICAL THERAPY AND WELLNESS CONSULTANTS
Practice Location Address:

6302 FAIRVIEW RD STE 100
CHARLOTTE, NC
28210-2227

Practice Phone: 704-401-4937
Practice Fax:

Directions to “MECKLENBURG OPEN DOOR, INC. ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.