Provider Demographics
NPI:1265047369
Name:THE BLANCHARD INSTITUTE
Entity type:Organization
Organization Name:THE BLANCHARD INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BUSINESS OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:OPALAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-414-7239
Mailing Address - Street 1:10348 PARK RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-8507
Mailing Address - Country:US
Mailing Address - Phone:704-414-7239
Mailing Address - Fax:704-817-7421
Practice Address - Street 1:19902 N COVE RD
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-6571
Practice Address - Country:US
Practice Address - Phone:704-584-4111
Practice Address - Fax:704-266-1996
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE BLANCHARD INSTITUTE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-09-15
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCMHL-060-1457OtherSTATE LICENSE