Provider Demographics
NPI:1760663058
Name:AMERICARE DEVELOPMENTAL SERVICES
Entity Type:Organization
Organization Name:AMERICARE DEVELOPMENTAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PERRY
Authorized Official - Middle Name:TANIS
Authorized Official - Last Name:WATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MPA
Authorized Official - Phone:704-506-6888
Mailing Address - Street 1:PO BOX 217125
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28221-0125
Mailing Address - Country:US
Mailing Address - Phone:704-506-6888
Mailing Address - Fax:704-378-0363
Practice Address - Street 1:313 HARRILL RD
Practice Address - Street 2:
Practice Address - City:FOREST CITY
Practice Address - State:NC
Practice Address - Zip Code:28043
Practice Address - Country:US
Practice Address - Phone:704-506-6888
Practice Address - Fax:704-378-0363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6604253Medicaid