AUTISM SERVICES OF MECKLENBURG COUNTY, INC.

Provider Demographics

• NPI: 1477683308
• Name: AUTISM SERVICES OF MECKLENBURG COUNTY, INC.
• Entity Type: Organization
• Organization Name: AUTISM SERVICES OF MECKLENBURG COUNTY, INC.
• Authorized Official - Title/Position: BUSINESS MANAGER
• Authorized Official - First Name: MARCY
• Authorized Official - Last Name: ALFORD
• Authorized Official - Phone: 704-392-9220
• Mailing Address - Street 1: 2211-A EXECUTIVE STREET
• Mailing Address - City: CHARLOTTE
• Mailing Address - State: NC
• Mailing Address - Zip Code: 28208-3655
• Mailing Address - Country: US
• Mailing Address - Phone: 704-392-9220
• Mailing Address - Fax: 704-392-9221
• Practice Address - Street 1: 2211-A EXECUTIVE STREET
• Practice Address - City: CHARLOTTE
• Practice Address - State: NC
• Practice Address - Zip Code: 28208-3655
• Practice Address - Country: US
• Practice Address - Phone: 704-392-9220
• Practice Address - Fax: 704-392-9221
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2007-03-07
• Last Update Date: 2018-09-13

Provider Licenses

State	License ID	Taxonomies
NC		251S00000X
NC	MHL-060-231	310500000X
NC	MHL-060-167	310500000X
NC	MHL-060-118	310500000X
NC	MHL-060-514	310500000X
NC	MHL-060-350	311ZA0620X
NC	MHL-060-908	311ZA0620X
NC	MHL-060-468	311ZA0620X
NC	MHL-060-166	311ZA0620X
		315P00000X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	310500000X	Nursing & Custodial Care Facilities	Intermediate Care Facility, Mental Illness
No	251S00000X	Agencies	Community/Behavioral Health
No	311ZA0620X	Nursing & Custodial Care Facilities	Custodial Care Facility	Adult Care Home
No	315P00000X	Nursing & Custodial Care Facilities	Intermediate Care Facility, Intellectual Disabilities

Provider Identifiers

State	Identifier ID	ID Type	Issuer
NC	3406362	Medicaid
NC	7803089	Medicaid
NC	3408804	Medicaid
NC	7804897	Medicaid
NC	340602B	Medicaid
NC	3406022	Medicaid
NC	340609A	Medicaid
NC	341612T	Medicaid
NC	7802270	Medicaid