A. JACK WALL GROUP HOME
NPI 1689749889
Residential Treatment Facility, Intellectual and/or Developmental Disabilities in Albemarle, NC
- Organization
- Residential Treatment Facility, Intellec...
About A. JACK WALL GROUP HOME
This page provides the complete NPI Profile along with additional information for A. Jack Wall Group Home, a provider established in Albemarle, North Carolina operating as a Residential Treatment Facility, Intellectual And/or Developmental Disabilities. The healthcare provider is registered in the NPI registry with number 1689749889 assigned on November 2006. The practitioner's primary taxonomy code is 320600000X with license number MHL084017 (NC). The provider is registered as an organization and their NPI record was last updated 11 years ago. The provider's is doing business as A. Jack Wall Group Home. The authorized official of this NPI record is Mrs. Dawn Harwood Allen (Ceo)
- NPI
- 1689749889 Verify this NPI
- Provider Legal Name
- GHA AUTISM SUPPORTS
- Other Organization Name
- A. JACK WALL GROUP HOME
- Other Name Type
- Doing Business As (3)
- Entity Type
- Organization
- Location Address
- 1213 MOSS SPRINGS ROAD ALBEMARLE, NC 28001
- Location Phone
- (704) 982-9600
- Location Fax
- (704) 982-8155
- Mailing Address
- PO BOX 2487 ALBEMARLE, NC 28002
- Mailing Phone
- (704) 982-9600
- Mailing Fax
- (704) 982-8155
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 11-22-2006
- Last Update Date
- 07-15-2015
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Residential Treatment Facility, Intellectual and/or Developmental Disabilities
- Taxonomy Code
- 320600000X
- Type
- Residential Treatment Facilities
- License No.
- MHL084017
- License State
- NC
- Taxonomy Description
- A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental and intellectual disabilities and are not able to live independently.
Secondary Taxonomies
The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.
| No. | Taxonomy Code | Type | Classification / Specialization |
License No. (State) |
|---|---|---|---|---|
| 1 | 315P00000X | Nursing & Custodial Care Facilities | Intermediate Care Facility, Intellectual Disabilities | MHL084017 (NC) |
| 2 | 323P00000X | Residential Treatment Facilities | Psychiatric Residential Treatment Facility | MHL084017 (NC) |
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| 3406165 | MEDICAID (05) | NC |
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Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1689749889, enumerated as an "organization" on November 22, 2006.
The provider is located at 1213 MOSS SPRINGS ROAD ALBEMARLE, NC 28001 and the phone number is (704) 982-9600.
Residential Treatment Facility, Intellectual and/or Developmental Disabilities with taxonomy code 320600000X.
The provider might be accepting Accepts: Medicare and Medicaid. Please consult your insurance carrier or call the provider to verify.
