Provider Demographics
NPI:1134566193
Name:UNITED METHODIST AGENCY FOR THE RETARDED WESTERN NORTH CAROLINA, INC
Entity type:Organization
Organization Name:UNITED METHODIST AGENCY FOR THE RETARDED WESTERN NORTH CAROLINA, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHURCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-659-7620
Mailing Address - Street 1:9800 KINCEY AVE
Mailing Address - Street 2:PO BOX 1558
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-8415
Mailing Address - Country:US
Mailing Address - Phone:704-659-7636
Mailing Address - Fax:
Practice Address - Street 1:1025 E 36TH ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-1652
Practice Address - Country:US
Practice Address - Phone:704-348-0994
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-31
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL0601044251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7802810Medicaid
NC7802987Medicaid
NC7803010Medicaid
NC7803215Medicaid
NC7803966Medicaid
NC7805458Medicaid
NC7802369Medicaid
NC7802744Medicaid
NC7804103Medicaid
NC7806020Medicaid
NC7802523Medicaid
NC7804012Medicaid
NC7806126Medicaid
NC7802200Medicaid
NC7802516Medicaid
NC7804104Medicaid
NC7804278Medicaid
NC3408796Medicaid
NC7802198Medicaid
NC7802643Medicaid
NC7805230Medicaid
NC7805306Medicaid
NC7804065Medicaid
NC7806141Medicaid