Provider Demographics
NPI:1194916122
Name:COMMUNITY TREATMENT ALTERNATIVES, INC
Entity type:Organization
Organization Name:COMMUNITY TREATMENT ALTERNATIVES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEPASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-323-9266
Mailing Address - Street 1:5410 FREDERICK STREET
Mailing Address - Street 2:
Mailing Address - City:INDIAN TRAIL
Mailing Address - State:NC
Mailing Address - Zip Code:28079-6509
Mailing Address - Country:US
Mailing Address - Phone:704-323-9266
Mailing Address - Fax:
Practice Address - Street 1:4901 ROSENA DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28227-3007
Practice Address - Country:US
Practice Address - Phone:704-563-8400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8301762BMedicaid