Provider Demographics
NPI:1497800726
Name:GOLDEN RULE OF CHARLOTTE
Entity Type:Organization
Organization Name:GOLDEN RULE OF CHARLOTTE
Other - Org Name:PEACHTREE
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:HATTIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:MALONE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:704-532-0566
Mailing Address - Street 1:1535 PEACHTREE RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-1607
Mailing Address - Country:US
Mailing Address - Phone:704-532-0566
Mailing Address - Fax:704-532-0144
Practice Address - Street 1:1535 PEACHTREE RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28216-1607
Practice Address - Country:US
Practice Address - Phone:704-532-0566
Practice Address - Fax:704-532-0144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-060-869322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6603428Medicaid