Provider Demographics
NPI:1891814737
Name:INREACH
Entity Type:Organization
Organization Name:INREACH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:GOUGEON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-536-6661
Mailing Address - Street 1:4530 PARK RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-3790
Mailing Address - Country:US
Mailing Address - Phone:704-536-6661
Mailing Address - Fax:704-536-0074
Practice Address - Street 1:3018 CROSBY RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-2817
Practice Address - Country:US
Practice Address - Phone:704-366-8667
Practice Address - Fax:704-536-0074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X, 311ZA0620X
NC060-161320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No251S00000XAgenciesCommunity/Behavioral Health
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCMHL-060-161OtherNC DEPARTMENT OF HEALTH AND HUMAN SERVICES
NC7802248Medicaid