1912158643 NPI number — SANDHILLS CENTER FOR MENTAL HEALTH, DEVELOPMENTAL DISABILITIES AND SUB

Table of content: (NPI 1912158643)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912158643 NPI number — SANDHILLS CENTER FOR MENTAL HEALTH, DEVELOPMENTAL DISABILITIES AND SUB

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SANDHILLS CENTER FOR MENTAL HEALTH, DEVELOPMENTAL DISABILITIES AND SUB
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:
1912158643
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST END
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27376-0009
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-673-9111
Provider Business Mailing Address Fax Number:
910-673-6202

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1116 SEVEN LAKES DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST END
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27376-0009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-673-9111
Provider Business Practice Location Address Fax Number:
910-673-2015
Provider Enumeration Date:
09/30/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SCOTT
Authorized Official First Name:
TOMMY
Authorized Official Middle Name:
E.
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
910-673-9111

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 6005505 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com