Provider Demographics
NPI:1740840990
Name:ALEXANDER YOUTH NETWORK
Entity type:Organization
Organization Name:ALEXANDER YOUTH NETWORK
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CONTRACTS MGR.
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-366-8712
Mailing Address - Street 1:6220 THERMAL RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-5630
Mailing Address - Country:US
Mailing Address - Phone:704-362-6759
Mailing Address - Fax:704-362-8464
Practice Address - Street 1:1601 HUFFINE MILL RD., BLDG B
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-5509
Practice Address - Country:US
Practice Address - Phone:336-375-8333
Practice Address - Fax:336-651-0444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-19
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCMHL-041-224OtherNC DHSR