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<br />State of North Carolina <br />Division of Social Services <br />Contract Applicatiol1' <br /> <br />Pag.e 5 of! 0 <br /> <br />Any additional services should be listed in ill 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: 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 ill Number K13048 <br /> <br />2. Countv Department of Social Services <br /> <br />a. Name of Contract Administrator: James F. Cook, Jr., Director <br />Telephone Number: (704) 920-1400 <br /> <br />b. Name of Services Program Contact Person: Maria Cooper <br />Telephone Number: (704) 920-1524 <br /> <br />c. <br /> <br />Address of County Department of Social Services: <br />1303 South Cannon Boulevard <br />Kannapolis. NC 28083 <br /> <br />DSS-1292 (4187) <br />Family Services <br /> <br />t="'-J..1 <br />