Provider Demographics
NPI:1336290154
Name:ALTERNATIVE DIRECTIONS HEALTHCARE, LLC
Entity Type:Organization
Organization Name:ALTERNATIVE DIRECTIONS HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGG
Authorized Official - Middle Name:
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:QMHP,QSAP
Authorized Official - Phone:704-499-3020
Mailing Address - Street 1:9023 NOTTOWAY DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-3533
Mailing Address - Country:US
Mailing Address - Phone:704-499-3020
Mailing Address - Fax:704-499-3020
Practice Address - Street 1:9023 NOTTOWAY DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28213-3533
Practice Address - Country:US
Practice Address - Phone:704-499-3020
Practice Address - Fax:704-499-3020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-060-783322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC660-3944Medicaid