1225042104 NPI number — CHARLOTTE-MECKLENBURG HEALTH SERVICES FOUNDATION

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225042104 NPI number — CHARLOTTE-MECKLENBURG HEALTH SERVICES FOUNDATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHARLOTTE-MECKLENBURG HEALTH SERVICES FOUNDATION
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:
DEPARTMENT OF MENTAL HEALTH
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:
1225042104
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/19/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 32861
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28232-2861
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-512-6438
Provider Business Mailing Address Fax Number:
704-512-6485

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 BLYTHE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28203-5812
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-355-2000
Provider Business Practice Location Address Fax Number:
704-355-5073
Provider Enumeration Date:
07/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
UNDERWOOD
Authorized Official First Name:
DENNIE
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
704-355-3147

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 890226H , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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