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<br /> <br />State of North Carolina <br />Division of Social Services <br />Contract Application <br /> <br />Page 5 of 10 <br /> <br />Any additional services should be listed in III Service Program Description <br /> <br />D. Area to be served: <br />Cabarrus County <br /> <br />E. Contract Identification: <br /> <br />1. Provider <br /> <br />a. Name of Contract Administrator Mr. Dan Caughlin. <br />Telephone Number: (704) 721-7000 <br /> <br />b. Name of Program Contact Person: Ms. Tammy Gilmore <br />Telephone Number: (704) 704-721-2700 <br /> <br />c. Program Name, Location and Mailing Address: <br /> <br />Piedmont. Behavioral Healthcare <br />457 Lake Concord Road, Concord, NC 28-25 <br /> <br />d. Additional Service Delivery Sites: <br /> <br />Homes of Clients in <br /> <br />Cabarrus County. <br /> <br />e. <br /> <br />Statue: (X) Public <br />( ) Private, for profit <br /> <br />( ) Private, non-profit <br />( ) Individual <br /> <br />f Provider rD Number K13048 <br /> <br />2. County Department of Social Services <br /> <br />a. Name of Contract Administrator: James F. Cook, Jr., Director <br />Telephone Number: (704) 939-1400 <br /> <br />b. Name of Services Program Contact Person: Natasha Jefferies <br />Telephone Number: (704) 920-1527 <br /> <br />/ <br />, <br /> <br />c. Address of County Department of Social Services: <br />1303 South Cannon Boulevard <br />Kannapolis. NC 28083 <br /> <br />DSS-1292 (4/87) <br />Family Services <br /> <br />r.'7 <br /> <br />II <br />