Basic Information
| Provider Information | |||||||||
| NPI: | 1659558922 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MCLEOD ADDICTIVE DISEASE CENTER, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 515 CLANTON RD | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282171309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7043329001 | ||||||||
| FaxNumber: | 7043325903 | ||||||||
| Practice Location | |||||||||
| Address1: | 636 SIGNAL HILL DRIVE EXTENSION | ||||||||
| Address2: | |||||||||
| City: | STATESVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286254353 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7048712992 | ||||||||
| FaxNumber: | 7048712994 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2008 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | WARD | ||||||||
| AuthorizedOfficialFirstName: | MARY | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7043329001 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0405X | MHL-049-101 | NC | N | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder | 251S00000X | MHL-049-101 | NC | Y | Agencies | Community/Behavioral Health |
No ID Information.