1659560472 NPI number — CAROLINAS MEDICAL CENTER

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 1659560472 NPI number — CAROLINAS MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAROLINAS MEDICAL CENTER
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:
CHS BEHAVIORAL HEALTH PARTIAL HOSPITALIZATION
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:
1659560472
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/21/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
501 BILLINGSLEY ROAD
Provider Second Line Business Mailing Address:
CHS BEHAVIORAL HEALTH CHARLOTTE ADMINISTRATION
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28211-1009
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-358-2710
Provider Business Mailing Address Fax Number:
704-358-2938

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 BILLINGSLEY ROAD
Provider Second Line Business Practice Location Address:
CHS BEHAVIORAL HEALTH CHARLOTTE ADMINISTRATION
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28211-1009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-358-2710
Provider Business Practice Location Address Fax Number:
704-358-2938
Provider Enumeration Date:
10/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DEFURIO
Authorized Official First Name:
ANTHONY
Authorized Official Middle Name:
Authorized Official Title or Position:
EVP AND CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
704-355-3304

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0850X , with the licence number: MHL-060-009 , 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: 8300443D , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com