Basic Information
| Provider Information | |||||||||
| NPI: | 1942421862 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | YOUTH ADULT CARE MANAGEMENT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1013 | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280261013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7049333505 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1605 OLD EARNHARDT RD | ||||||||
| Address2: | |||||||||
| City: | KANNAPOLIS | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280838025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7049333505 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BLACK | ||||||||
| AuthorizedOfficialFirstName: | CHON | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7049333505 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 322D00000X | Y | Residential Treatment Facilities | Residential Treatment Facility, Emotionally Disturbed Children |
No ID Information.