Basic Information
| Provider Information | |||||||||
| NPI: | 1437472651 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MONARCH | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | COLDWATER | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 350 PEE DEE AVE | ||||||||
| Address2: | SUITE A | ||||||||
| City: | ALBEMARLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280014945 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7049861522 | ||||||||
| FaxNumber: | 7049825279 | ||||||||
| Practice Location | |||||||||
| Address1: | 43 RIDGE CT SE | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280253836 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7047209194 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/02/2010 | ||||||||
| LastUpdateDate: | 03/02/2010 | ||||||||
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| AuthorizedOfficialLastName: | JONES | ||||||||
| AuthorizedOfficialFirstName: | CINDY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 7049861522 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 311ZA0620X | MHL 013 143 | NC | N | Nursing & Custodial Care Facilities | Custodial Care Facility | Adult Care Home | 320600000X | Y | Residential Treatment Facilities | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
No ID Information.