Provider Demographics
NPI:1891841524
Name:COMMUNITY TREATMENT ALTERNATIVES
Entity Type:Organization
Organization Name:COMMUNITY TREATMENT ALTERNATIVES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEPASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-323-9266
Mailing Address - Street 1:PO BOX 215
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28106-0215
Mailing Address - Country:US
Mailing Address - Phone:704-323-9266
Mailing Address - Fax:
Practice Address - Street 1:2005 BREEZEWOOD DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-1423
Practice Address - Country:US
Practice Address - Phone:704-323-9266
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC060-739320800000X
NCMHL#060-739322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6603933Medicaid