Basic Information
Provider Information | |||||||||
NPI: | 1588840318 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | CHEROKEE INDIAN HOSPITAL AUTHORITY | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | CIHA ANALENSGI CLINIC | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1 HOSPITAL RD | ||||||||
Address2: | CALLER BOX C-268 | ||||||||
City: | CHEROKEE | ||||||||
State: | NC | ||||||||
PostalCode: | 287199253 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8284979163 | ||||||||
FaxNumber: | 8284971723 | ||||||||
Practice Location | |||||||||
Address1: | 149 CHEROKEE HOSPITAL LOOP | ||||||||
Address2: |   | ||||||||
City: | CHEROKEE | ||||||||
State: | NC | ||||||||
PostalCode: | 28719 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8284979163 | ||||||||
FaxNumber: | 8285545560 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/10/2008 | ||||||||
LastUpdateDate: | 01/05/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | OWLE | ||||||||
AuthorizedOfficialFirstName: | GINGER | ||||||||
AuthorizedOfficialMiddleName: | KAY | ||||||||
AuthorizedOfficialTitleorPosition: | BUSINESS DIRECTOR | ||||||||
AuthorizedOfficialTelephone: | 8284979163 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | Y | ||||||||
ParentOrganizationLBN: | CHEROKEE INDIAN HOSPITAL AUTHORITY | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 01/05/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X |   |   | N |   | Agencies | Case Management |   | 251S00000X |   |   | N |   | Agencies | Community/Behavioral Health |   | 101YA0400X |   |   | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YM0800X |   |   | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health | 261QM0801X |   |   | N |   | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | 261QM0801X |   | NC | N |   | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | 261QM0850X |   |   | N |   | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | 261QM0855X |   |   | N |   | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health | 283Q00000X |   |   | N |   | Hospitals | Psychiatric Hospital |   | 1041C0700X |   |   | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
ID | Type | State | Issuer | Description | NONE | 01 |   | CLIA | OTHER | 3460156 | 05 | NC |   | MEDICAID |