Basic Information
| Provider Information | |||||||||
| NPI: | 1366462897 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MERIDIAN BEHAVIORAL HEALTH SERVICES, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MERIDIAN BEHAVIORAL HEALTH | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2187 | ||||||||
| Address2: | |||||||||
| City: | SYLVA | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287792187 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286313973 | ||||||||
| FaxNumber: | 8286319280 | ||||||||
| Practice Location | |||||||||
| Address1: | 44 BONNIE LN | ||||||||
| Address2: | |||||||||
| City: | SYLVA | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287798511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286313973 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2006 | ||||||||
| LastUpdateDate: | 02/06/2019 | ||||||||
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| AuthorizedOfficialLastName: | JUSTUS | ||||||||
| AuthorizedOfficialFirstName: | TORRIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8286313973 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | JD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 017FK | 01 | NC | BCBS NC | OTHER |