MEDICARE: ECHELON CARE

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	101YM0800X	Mental Health Counselor	MHL060959	NC
2	320800000X	Mental Illness Community Based Residential Treatment Facility	6603878	NC
3	322D00000X	Emotionally Disturbed Childrens' Residential Treatment Facility	060959	NC
4	251S00000X	Community/Behavioral Health Agency	6603878	NC

General Provider Information

NPI Number	:	1760506919
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ECHELON CARE

Provider Business Mailing Address
First Line	:	7209J WT HARRIS BLVD
Second Line	:	SUITE 207
City	:	CHARLOTTE
State	:	NC
Zip	:	28227
Country	:	US
Telephone Number	:	704-594-9119
Fax Number	:	704-909-2829

Provider Business Practice Location Address
First Line	:	4508 CARRIAGE DRIVE CIR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28205
Country	:	US
Telephone Number	:	704-594-9119
Fax Number	:	704-594-9915

Authorized Official
Title or Position	:	PRESIDENT OWNER
Name	:	ALEX WRIGHT
Credential	:
Telephone Number	:	704-594-9119

Provider Enumeration Date	:	03/16/2007
Last Update Date	:	03/13/2024

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Directions to “ECHELON CARE ” Practice Location

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