Provider Demographics
NPI:1427409978
Name:ALTERNATIVE LIVING SOLUTIONS OF NORTH CAROLINA
Entity Type:Organization
Organization Name:ALTERNATIVE LIVING SOLUTIONS OF NORTH CAROLINA
Other - Org Name:ALTERNATIVE LIVING SOLUTIONS OF NORTH CAROLINA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:SHINE
Authorized Official - Suffix:
Authorized Official - Credentials:CSAC
Authorized Official - Phone:704-621-0566
Mailing Address - Street 1:8420 MEDICAL PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-9748
Mailing Address - Country:US
Mailing Address - Phone:704-612-0566
Mailing Address - Fax:704-498-4846
Practice Address - Street 1:140 CABARRUS AVE W
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-5150
Practice Address - Country:US
Practice Address - Phone:704-612-0566
Practice Address - Fax:704-498-4846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1427409978Medicaid