1023131711 NPI number — ALAMANCE CASWELL AREA MH DD SA AREA AUTHORITY

Table of content: (NPI 1023131711)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023131711 NPI number — ALAMANCE CASWELL AREA MH DD SA AREA AUTHORITY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALAMANCE CASWELL AREA MH DD SA AREA AUTHORITY
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:
ALAMANCE CASWELL AREA MH DD SA SERVICES
Provider Other Organization Name Type Code:
5
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:
1023131711
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/19/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
319 N GRAHAM HOPEDALE RD
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
BURLINGTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27217-2992
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-513-4200
Provider Business Mailing Address Fax Number:
336-513-4379

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
319 N GRAHAM HOPEDALE RD
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
BURLINGTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27217-2992
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-513-4200
Provider Business Practice Location Address Fax Number:
336-513-4379
Provider Enumeration Date:
04/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MCCAIN
Authorized Official First Name:
CLAYRON
Authorized Official Middle Name:
BRYAN
Authorized Official Title or Position:
REIMBURSEMENT OFFICER
Authorized Official Telephone Number:
336-513-4200

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X , with the licence number:  MHL001056 , 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)

  • Identifier: 5901663 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 07053 . This is a "BLUE CROSS BLUE SHIELD NC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 3404920 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6005767 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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