Provider Demographics
NPI:1073883328
Name:THE MANDALAY GROUP 1
Entity Type:Organization
Organization Name:THE MANDALAY GROUP 1
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:MARIAN
Authorized Official - Last Name:FLETCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-849-9132
Mailing Address - Street 1:2429 BLUEBERRY RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-4167
Mailing Address - Country:US
Mailing Address - Phone:704-849-9132
Mailing Address - Fax:704-321-9164
Practice Address - Street 1:2429 BLUEBERRY RIDGE RD
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-4167
Practice Address - Country:US
Practice Address - Phone:704-849-9132
Practice Address - Fax:704-321-9164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-04
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health