Provider Demographics
NPI:1831767334
Name:SIMTAS DEVELOPMENT GROUP
Entity type:Organization
Organization Name:SIMTAS DEVELOPMENT GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANTEE
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-807-9355
Mailing Address - Street 1:125 REMOUNT RD STE C1-1161
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-6458
Mailing Address - Country:US
Mailing Address - Phone:704-612-6600
Mailing Address - Fax:
Practice Address - Street 1:1025 AVONDALE RD
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:NC
Practice Address - Zip Code:28098-1714
Practice Address - Country:US
Practice Address - Phone:704-612-6600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-12
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness