Provider Demographics
NPI:1972166635
Name:BEATTIES FORD ROAD VOCATIONAL TRADE CENTER
Entity Type:Organization
Organization Name:BEATTIES FORD ROAD VOCATIONAL TRADE CENTER
Other - Org Name:BEATTIES FORD ROAD FAMILY COUNSELING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:FRANCES
Authorized Official - Middle Name:REBECCA
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:980-349-4067
Mailing Address - Street 1:1406 BEATTIES FORD RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-4550
Mailing Address - Country:US
Mailing Address - Phone:980-349-4067
Mailing Address - Fax:980-209-9717
Practice Address - Street 1:1406 BEATTIES FORD RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28216-4550
Practice Address - Country:US
Practice Address - Phone:980-349-4067
Practice Address - Fax:980-209-9717
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BEATTIES FORD ROAD VOCATIONAL TRADE CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-04-18
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamilyGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No333600000XSuppliersPharmacyGroup - Multi-Specialty