Basic Information
Provider Information | |||||||||
NPI: | 1649867896 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | NOVANT HEALTH NEW HANOVER REGIONAL MEDICAL CENTER LLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | NOVANT HEALTH NEW HANOVER BEHAVIORAL HEALTH HOSPITAL | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 101 N CHERRY ST STE 600 | ||||||||
Address2: |   | ||||||||
City: | WINSTON SALEM | ||||||||
State: | NC | ||||||||
PostalCode: | 271014013 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3362771604 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 2131 S 17TH ST | ||||||||
Address2: |   | ||||||||
City: | WILMINGTON | ||||||||
State: | NC | ||||||||
PostalCode: | 284017407 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9103437000 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/22/2020 | ||||||||
LastUpdateDate: | 08/19/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | STEVENS | ||||||||
AuthorizedOfficialFirstName: | SHELBOURN | ||||||||
AuthorizedOfficialMiddleName: | ODELL | ||||||||
AuthorizedOfficialTitleorPosition: | SVP & PRES NHNHRMC & COAST MKT ADMI | ||||||||
AuthorizedOfficialTelephone: | 9107211456 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 08/19/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X |   |   | N |   | Hospitals | General Acute Care Hospital |   | 273R00000X |   |   | Y |   | Hospital Units | Psychiatric Unit |   |
No ID Information.