BERTHA'S PLACE, INC. (NPI# 1063569127) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063569127 |
| Entity Type | Organization |
| Organization Name | BERTHA'S PLACE, INC. |
| Practice Address |
3412 Green Meadow Dr. Charlotte NC 28269-2982 |
| Mailing Address |
2424 Logan Field Dr. Waxhaw NC 28173-6962 |
| Practice Telephone | 7045985106 |
| Practice Fax Number | 7045985106 |
| Mailing Telephone | 7042434771 |
| Mailing Fax Number | 7042434771 |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MR. WAYNE LOUIS GARRIS (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 7045985106 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 322D00000X | Residential Treatment Facility, Emotionally Disturbed Children | MHL060-871 | NC | Residential Treatment Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | 6603939 | 05 |
| Street Address |
3412 GREEN MEADOW DR. |
| City | CHARLOTTE |
| State | NC |
| Zip Code | 28269-2982 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124664438 | Alluring Occupational Therapy Services, Pllc | Occupational Therapy Assistant | 3020-i Prosperity Church Rd, Ste 523, Charlotte, NC 28269 | 2019-11-21 |
| 1366085094 | Crystal R Currie | Counselor | 8824 Cliff Cameron Drive, Uint 107, Charlotte, NC 28269 | 2019-10-25 |
| 1477102879 | Apryl N. Davis | Occupational Therapy Assistant | 3020-i Prosperity Church Rd., Charlotte, NC 28269 | 2019-09-09 |
| 1730744202 | Christopher Paige | Driver | 9805 Statesville Rd., Suite 6198, Charlotte, NC 28269 | 2019-05-09 |
| 1619532892 | Krb Support Services | Prevention Professional | 11634 Oak Street, Charlotte, NC 28269 | 2019-05-03 |
| 1184186769 | Kimberly M Lynch | Local Education Agency (LEA) | 11634 Oat Street, Charlotte, NC 28269 | 2019-04-03 |
| 1356802318 | Arleen M Blythe | Physical Therapy Assistant | 1521 Bucklebury Ct, Charlotte, NC 28269 | 2019-03-30 |
| 1174089064 | Quality Behavioral Health Services, Pllc | Social Worker | 9805 Statesville Rd, # 6095, Charlotte, NC 28269 | 2019-02-15 |
| 1326517855 | Mary Frances Pickens-wilson | Behavior Technician | 4628 Quinton Lane, Charlotte, NC 28269 | 2018-11-14 |
| 1548746605 | Tiffany Michelle Graham | Counselor | 9823 Cooper Run Ln, Charlotte, NC 28269 | 2018-07-12 |
| Find all providers in zip 28269 | ||||
| Taxonomy Code | 322D00000X |
| Grouping | Residential Treatment Facilities |
| Classification | Residential Treatment Facility, Emotionally Disturbed Children |
| A provider facility or distinct part of the organization which renders an interdisciplinary program of mental health treatment to individuals under 21 years of age who have persistent dysfunction in major life areas. The dysfunction is of an extent and pervasiveness that requires a protected and highly structured therapeutic environment. These organizations, or distinct part of organizations, exclude those that provide acute psychiatric care, partial hospitalization, group living, therapeutic schooling, primary diagnosis substance abuse disorder treatment, or primary diagnosis mental retardation or developmental disability treatment. |
| Notes: Source: U.S. Department of Defense Regulation 6010.8-R, Chapter 6. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679058440 | Miracle Houses Inc | Residential Treatment Facility, Emotionally Disturbed Children | 7827 Kerrybrook Cir, Charlotte, NC 28214-2513 | 2018-09-27 |
| 1174048078 | A Safe Place Community Housing, LLC | Residential Treatment Facility, Emotionally Disturbed Children | 2049 Highland St, Charlotte, NC 28208-4909 | 2017-08-11 |
| 1740720036 | New Place, Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 5419 Twin Ln, Charlotte, NC 28269-4635 | 2017-03-06 |
| 1336385699 | 1st Choice Professional Services, Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 10532 Green Hedge Ave, Charlotte, NC 28269-1541 | 2008-12-16 |
| 1578735866 | New Place, Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 8134 Strawberry Point Dr, Charlotte, NC 28215-8487 | 2008-03-27 |
| 1194901157 | Echelon Consulting Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 2139 Jennie Linn Dr, Charlotte, NC 28215-2925 | 2008-01-21 |
| 1558547513 | Echelon Consulting Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 4724 Carriage Drive Cir, Charlotte, NC 28205-4922 | 2008-01-21 |
| 1972798841 | Walkers Group Home | Residential Treatment Facility, Emotionally Disturbed Children | 5719 Kinglet Ln, Charlotte, NC 28269-7113 | 2007-09-13 |
| 1528188802 | Murray Adolescent Training & Txment Academy | Residential Treatment Facility, Emotionally Disturbed Children | 2012 Commonwealth Ave, Charlotte, NC 28205-5022 | 2007-03-30 |
| 1760506919 | Echelon Consulting Inc | Residential Treatment Facility, Emotionally Disturbed Children | 4508 Carriage Drive Cir, Charlotte, NC 28205 | 2007-03-16 |
| Find all providers in CHARLOTTE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.