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<br />State of North Carolina <br />Division of Social Services <br />Contract Application <br /> <br />Contract Summary <br /> <br />E. Contract Identification: <br /> <br />1 . Provider <br /> <br />a. <br /> <br />Name of Cohtract Administrator <br /> <br />Tel. #: <br /> <br />704-788-5832 <br /> <br />Steve Ba1don <br />Board Chairperson <br /> <br />b. <br /> <br />Name of Program Contact Person: <br /> <br />Tel. # ; <br /> <br />704-788-1215 <br /> <br />Mrs. Susan Caudle <br />Executive Director <br /> <br />c. Program Name, Location and Mailing Address: <br /> <br />Coltrane LIFE Center, Inc. <br />321 Corban Ave.SEast. Concord, NC 28025 <br /> <br />d. Additional Service Delivery Sites: <br /> <br />e. <br /> <br />Status: <br /> <br />Public <br />Private, <br /> <br />(x) Private, non-profit <br />for profit ( ) Individual <br /> <br />f. Provider ID #: K13001 <br /> <br />2. County Department of Socia~ Services <br /> <br />a. <br /> <br />Name of Contract Administrator: <br />Tel. #: (704) 920-1400 <br /> <br />James F. Cook, Jr. <br />Director <br /> <br />b. <br /> <br />Name of Services Program Contact Person <br /> <br />Tanuny Bare <br />Social Worker <br /> <br />Tel. #: <br /> <br />(704) 920-1400 <br /> <br />c. Address of County Department of Social Services: <br />1303 S. Cannon Blvd. <br />Kannapolis, NC 28083 <br /> <br />r-b <br />