1639357429 NPI number — SBH-WILMINGTON LLC

Table of content: (NPI 1639357429)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639357429 NPI number — SBH-WILMINGTON LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SBH-WILMINGTON LLC
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:
CAROLINA DUNES BEHAVIORAL HEALTH
Provider Other Organization Name Type Code:
3
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:
1639357429
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8275 TOURNAMENT DR
Provider Second Line Business Mailing Address:
SUITE 150
Provider Business Mailing Address City Name:
MEMPHIS
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38125-8899
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-969-3100
Provider Business Mailing Address Fax Number:
901-969-3120

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2050 MERCANTILE DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LELAND
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28451
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-371-2500
Provider Business Practice Location Address Fax Number:
910-371-2508
Provider Enumeration Date:
02/05/2008

Additional Information

Authorized Official

Authorized Official Last Name:
GILBERT
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF LEGAL OFFICER
Authorized Official Telephone Number:
615-716-4924

Provider Taxonomy Codes

  • Taxonomy code: 283Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 323P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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