1093828881 NPI number — THE CHRYSALIS FOUNDATION FOR MENTAL HEALTH, INC.-HOPE MEADOW PROGRAM

Table of content: (NPI 1093828881)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093828881 NPI number — THE CHRYSALIS FOUNDATION FOR MENTAL HEALTH, INC.-HOPE MEADOW PROGRAM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE CHRYSALIS FOUNDATION FOR MENTAL HEALTH, INC.-HOPE MEADOW PROGRAM
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:
FAMILY WELLNESS AND RECOVERY SERVICES OF NC, INC.
Provider Other Organization Name Type Code:
4
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:
1093828881
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/12/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 E WEAVER ST
Provider Second Line Business Mailing Address:
STE. G-7
Provider Business Mailing Address City Name:
CARRBORO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27510-2370
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-933-0770
Provider Business Mailing Address Fax Number:
919-933-0767

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
263 PENNY LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PITTSBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27312-4918
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-968-8680
Provider Business Practice Location Address Fax Number:
919-968-9970
Provider Enumeration Date:
08/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SUTTER
Authorized Official First Name:
JEAN
Authorized Official Middle Name:
THERESE
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
919-933-0770

Provider Taxonomy Codes

  • Taxonomy code: 324500000X , with the licence number:  MHL-019017 , 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: 6110548 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8300816B , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8300816G , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8302193P , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8300816 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8300816P , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8302193G , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6005680 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6106030 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8302193 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6000789 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6103305 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8302193B , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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