A. Jack Wall Group Home
LBN: Gha Autism Supports
A. Jack Wall Group Home is an health care organization with primary practice located at 1213 Moss Springs Road , Albemarle NC 28001-7810. The organization recently has 3 registered licenses in different health care specialties including Nursing & Custodial Care Facilities / Intermediate Care Facility, Mentally Retarded, Residential Treatment Facilities / Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities, Residential Treatment Facilities / Psychiatric Residential Treatment Facility. Residential Treatment Facilities / Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities is the primary health care specialty.
Gha Autism Supports can be contacted via phone (704) 982-9600, or through Allen, Dawn Harwood via phone (704) 982-9600.
Contact Information
Primary practice address
1213 Moss Springs Road
Albemarle NC 28001-7810
Phone: (704) 982-9600
Fax: (704) 982-8155
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Nursing & Custodial Care Facilities / Intermediate Care Facility, Mentally Retarded | 315P00000X | MHL084017 | North Carolina |
| Residential Treatment Facilities / Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 320600000X | MHL084017 | North Carolina |
| Residential Treatment Facilities / Psychiatric Residential Treatment Facility | 323P00000X | MHL084017 | North Carolina |
Profile Details
| NPI number | 1689749889 |
|---|---|
| LBN Legal business name | Gha Autism Supports |
| DBA Doing business as | A. Jack Wall Group Home |
| Authorized official | Allen, Dawn Harwood |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Nov 22nd, 2006 |
| Last updated | Jul 15th, 2015 - about 9 years ago |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1689749889 | NPPES |
| North Carolina | MEDICAID | 3406165 |
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