Basic Information
| Provider Information | |||||||||
| NPI: | 1295894202 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ONSLOW CARTERET BEHAVIORAL HEALTHCARE SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 165 CENTER ST | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 285465708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9102198000 | ||||||||
| FaxNumber: | 9103534765 | ||||||||
| Practice Location | |||||||||
| Address1: | 215 MEMORIAL DR | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 285466333 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9103535118 | ||||||||
| FaxNumber: | 9103534765 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | JONES | ||||||||
| AuthorizedOfficialFirstName: | DANIEL | ||||||||
| AuthorizedOfficialMiddleName: | M. | ||||||||
| AuthorizedOfficialTitleorPosition: | AREA DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9102198000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | MHL-067-002 | NC | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 5901887 | 01 | NC | PHYSICIAN GROUP | OTHER | 8301604 | 05 | NC | MEDICAID | 6005558 | 01 | NC | INDEP MH PRACTITIONER GRP | OTHER | 43021 | 01 | NC | STATE ID | OTHER | 3404934 | 05 | NC | MEDICAID |