Basic Information
| Provider Information | |||||||||
| NPI: | 1215105382 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE MENTAL HEALTH ASSOCIATION IN NORTH CAROLINA, INC. | ||||||||
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| OtherOrganizationName: | PERSON GH | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1331 SUNDAY DR | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276075166 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199810740 | ||||||||
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| Practice Location | |||||||||
| Address1: | 219 N FOUSHEE ST | ||||||||
| Address2: | |||||||||
| City: | ROXBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275735314 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3365985988 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/12/2008 | ||||||||
| LastUpdateDate: | 02/12/2008 | ||||||||
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| AuthorizedOfficialLastName: | COCHRAN | ||||||||
| AuthorizedOfficialFirstName: | KEVIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | A/R MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9198663287 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 320800000X | MHL-073-042 | NC | Y | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness |
ID Information
| ID | Type | State | Issuer | Description | 7804246 | 05 | NC | MEDICAID |