Provider Demographics
NPI:1285983528
Name:ALTERNATIVE COMMUNITY PENALTIES PROGRAM, INC.
Entity type:Organization
Organization Name:ALTERNATIVE COMMUNITY PENALTIES PROGRAM, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:LANCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-867-8749
Mailing Address - Street 1:P.O. BOX 370
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28053-0370
Mailing Address - Country:US
Mailing Address - Phone:704-671-1030
Mailing Address - Fax:704-869-7336
Practice Address - Street 1:400 EAST FIFTH AVENUE
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054
Practice Address - Country:US
Practice Address - Phone:704-867-8749
Practice Address - Fax:704-869-8892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-31
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-0360297320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness