1134389844 NPI number — BARIUM SPRINGS HOME FOR CHILDREN-ASSESSMENT & CLINICAL SERVICES

Table of content: (NPI 1134389844)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134389844 NPI number — BARIUM SPRINGS HOME FOR CHILDREN-ASSESSMENT & CLINICAL SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BARIUM SPRINGS HOME FOR CHILDREN-ASSESSMENT & CLINICAL SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134389844
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BARIUM SPRINGS
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28010-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-873-1011
Provider Business Mailing Address Fax Number:
704-924-7683

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
720 E 4TH ST
Provider Second Line Business Practice Location Address:
SUITE 400
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28202-2884
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-330-4338
Provider Business Practice Location Address Fax Number:
704-924-7683
Provider Enumeration Date:
06/16/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KOPPELMEYER
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
704-873-1011

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  3272 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)