1033481650 NPI number — SOUTHMOUNTAIN CHILDREN AND FAMILY SERVICES

Table of content: (NPI 1033481650)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033481650 NPI number — SOUTHMOUNTAIN CHILDREN AND FAMILY SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHMOUNTAIN CHILDREN AND FAMILY SERVICES
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:
Provider Other Organization Name Type Code:
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:
1033481650
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/12/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7330 MYRTLE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEBO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28761-8666
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-584-1105
Provider Business Mailing Address Fax Number:
828-584-8910

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 W UNION ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MORGANTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28655
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-584-1105
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/27/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
FISCHMAN
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
828-391-2744

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC2200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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