Laserfiche WebLink
<br />State of North Carolina <br />Division of Social Services <br />Contract Application <br /> <br />Contract Summary <br /> <br />E. <br /> <br />Contract Identification: <br /> <br />1. <br /> <br />Provider <br /> <br />a. <br /> <br />Name of Contract Administrator <br /> <br />Hugh Malone, MD <br />Board Chairperson <br /> <br />Tel.#,: <br /> <br />704-786-4304 <br /> <br />Mrs. Susan Caudlè <br />Executive Director <br /> <br />b. <br /> <br />Name of Program Contact Person: <br /> <br />Tel.#': <br /> <br />704- 7813-:-1.2;1.5 <br /> <br />c. <br /> <br />Program Name, Location and Mailing Address: <br /> <br />Coltrane LIFE Center, Inc. <br />321 Corban Ave.S.East. Concord, NC 28025 <br /> <br />,) <br /> <br />d. <br /> <br />Additional Service Delivery Sites: <br /> <br />e. <br /> <br />Status: <br /> <br />( ) Public (x) Private, non-profit <br />( ) Private, for profit ( ) Individual <br /> <br />f. <br /> <br />Provider ID #: K13001. <br /> <br />2. <br /> <br />County Department of Social 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 />.-----------.----- <br /> <br />Tammy Bare <br />Social Worker <br /> <br />b. <br /> <br />Name of Services Program Contact Person <br /> <br />Tel. #': <br /> <br />(704) 920-1400 <br /> <br />c. <br /> <br />Address of County Department of Social Services: <br />1303 S. Cannon Blvd. <br />Kannapolis, NC 28083 <br /> <br />I=- - (ø <br />