Provider Demographics
NPI:1598899205
Name:TOWERGATE YOUTH AND FAMILY SERVICES, INC.
Entity Type:Organization
Organization Name:TOWERGATE YOUTH AND FAMILY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:LESSANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-701-2123
Mailing Address - Street 1:PO BOX 822
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28026-0822
Mailing Address - Country:US
Mailing Address - Phone:704-701-2123
Mailing Address - Fax:704-793-1882
Practice Address - Street 1:501 MARY CHARLOTTE LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-0855
Practice Address - Country:US
Practice Address - Phone:704-701-2123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TOWERGATE YOUTH AND FAMILY SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-15
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-060-822320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6603316Medicaid