OrganizationActive
Youth Adult Care Management
NPI 1215061007 · Emotionally Disturbed Childrens' Residential Treatment Facility · Kannapolis, NC
Provider details
- NPI number
- 1215061007
- Entity type
- Organization
- Primary specialty
- Emotionally Disturbed Childrens' Residential Treatment FacilityResidential Treatment Facilities
- Organization subpart
- No
- Authorized official
- Chon Black, Director(704) 933-3505
- License
- MHL-080-121 (NC)
Specialties & taxonomies
- Emotionally Disturbed Childrens' Residential Treatment FacilityPrimary322D00000XLicense MHL-080-121 (NC)
Residential Treatment Facilities
Profile Score
Detailed profile(89/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
19 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
730 Jack St
Kannapolis, NC 28081-9573
Phone: (704) 933-3505
Street-level locationGet directions
Mailing address
Po Box 1013
Concord, NC 28026-1013
Registry dates
- Enumerated
- 2007-03-15
- Last updated
- 2007-08-01
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.