A. JACK WALL GROUP HOME – NPI #1689749889
Residential Treatment Facility, Intellectual and/or Developmental Disabilities
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.
A. JACK WALL GROUP HOME is a residential treatment facility located in ALBEMARLE, NC. NPPES has assigned the NPI number 1689749889 to A. JACK WALL GROUP HOME on November 22, 2006. It is a Type-2 NPI, indicating this NPI number is associated with an organization. Since the name “A. JACK WALL GROUP HOME” is a dba name, the actual legal business name for this organization is GHA AUTISM SUPPORTS. With multiple taxonomy codes selected, the primary taxonomy selected by this provider is 320600000X from the Health Care Provider Taxonomy code set, which is classified as Residential Treatment Facility, Intellectual and/or Developmental Disabilities.
The NPI profile was previously updated about 11 years ago on Jul 15, 2015. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for A. JACK WALL GROUP HOME below.
NPI Profile for
GHA AUTISM SUPPORTS
(more than 19 years ago)
ALBEMARLE, NC 28001-7810 Phone: (704) 982-9600 Fax: (704) 982-8155
ALBEMARLE, NC 28002-2487 Phone: (704) 982-9600 Fax: (704) 982-8155
CEO
Phone: (704) 982-9600
Identifiers for A. JACK WALL GROUP HOME
Identifiers are used to associate other provider identifiers such as Medicaid or other insurers (ie:, Blue Cross, Blue Shield, Aetna, Kaiser-Permanente, etc.), with their NPI number. These identifiers can be used in matching an NPI number to an insurer's records. However, not all providers have such numbers and not all providers choose to include them in their NPI information.
| Description | Issuer | State | Identifier |
|---|---|---|---|
| MEDICAID | NC | 3406165 |
A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.
| Taxonomy Classification / Specialization | State | License |
|---|---|---|
| 320600000X - Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Primary) |
NC | MHL084017 |
| 323P00000X - Psychiatric Residential Treatment Facility |
NC | MHL084017 |
| 315P00000X - Intermediate Care Facility, Intellectual Disabilities |
NC | MHL084017 |
The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.