Provider Demographics
NPI:1205996899
Name:ABOVE AND BEYOND ENTERPRISE
Entity type:Organization
Organization Name:ABOVE AND BEYOND ENTERPRISE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LONNIE
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:704-734-1040
Mailing Address - Street 1:PO BOX 682
Mailing Address - Street 2:
Mailing Address - City:KINGS MOUNTAIN
Mailing Address - State:NC
Mailing Address - Zip Code:28086-0682
Mailing Address - Country:US
Mailing Address - Phone:704-734-1040
Mailing Address - Fax:704-734-1095
Practice Address - Street 1:104 S CARPENTER ST
Practice Address - Street 2:
Practice Address - City:KINGS MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:28086-3415
Practice Address - Country:US
Practice Address - Phone:704-734-1040
Practice Address - Fax:704-734-1095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-023-108322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6603537Medicaid