MIDWOOD ADDICTION TREATMENT LLC NPI 1568941672

NPI Information

NPI: 1568941672
Provider Name: MIDWOOD ADDICTION TREATMENT, LLC
Classification: Clinic/Center - 261QR0405X
Entity Type: Organization

Specialization: Rehabilitation, Substance Use Disorder

CLIA Number: 34D2144902

Address:
1111 THE PLZ
CHARLOTTE, NC
ZIP 28205
Phone: (704) 625-2828
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MIDWOOD ADDICTION TREATMENT, LLC is a rehabilitation and substance use disorder clinic center in Charlotte, NC. MIDWOOD ADDICTION TREATMENT, LLC NPI is 1568941672. The provider is registered as an organization entity type.

The provider's business location address is:

1111 THE PLZ
CHARLOTTE, NC
ZIP 28205-039
Phone: (704) 625-2828

The provider's authorized official is David Farache .
The authorized official title is Ceo and has the following contact phone number (954) 744-3696.

The CLIA number assigned to this NPI record is 34D2144902 - other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/9/2018 and was last updated on 8/9/2018.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QR0405X	Clinic/Center	Rehabilitation, Substance Use Disorder	MHL-060-1367	NORTH CAROLINA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	MHL-060-1367	OTHER	NORTH CAROLINA	NC DHHR

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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