1407917081 NPI number — CAROLINA BEHAVIORAL CARE

Table of content: (NPI 1407917081)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407917081 NPI number — CAROLINA BEHAVIORAL CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAROLINA BEHAVIORAL CARE
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:
1407917081
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/15/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1630
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PINEHURST
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28370-1630
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-295-6007
Provider Business Mailing Address Fax Number:
910-215-0179

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
220 SMITH CHURCH RD
Provider Second Line Business Practice Location Address:
BUILDING C
Provider Business Practice Location Address City Name:
ROANOKE RAPIDS
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27870-4914
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-537-6619
Provider Business Practice Location Address Fax Number:
252-537-4961
Provider Enumeration Date:
12/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PESCE
Authorized Official First Name:
ELISABETH
Authorized Official Middle Name:
Authorized Official Title or Position:
SECRETARY
Authorized Official Telephone Number:
904-605-4986

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: 0122R . This is a "BCBS GROUP" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 5904753 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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