OrganizationActive
Autism Services of Mecklenburg County, Inc.
NPI 1043561764 · Intellectual Disabilities Intermediate Care Facility · Charlotte, NC
Provider details
- NPI number
- 1043561764
- Entity type
- Organization
- Primary specialty
- Intellectual Disabilities Intermediate Care FacilityNursing & Custodial Care Facilities
- Organization subpart
- No
- Authorized official
- Jack Phillips, Executive Director/Ceo(704) 392-9220
- License
- MHL-060-231 (NC)
Specialties & taxonomies
Nursing & Custodial Care Facilities
Practice location
1123 Ravendale Dr
Charlotte, NC 28216-1526
Phone: (704) 399-3538
Approximate (ZIP-level) locationGet directions
Mailing address
2211 Executive St
Charlotte, NC 28208-3661
Registry dates
- Enumerated
- 2012-09-20
- Last updated
- 2012-09-20
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.