Basic Information
| Provider Information | |||||||||
| NPI: | 1699816140 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MONARCH | ||||||||
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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: | 142 MALLARD LN | ||||||||
| Address2: | |||||||||
| City: | ROCKINGHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283795200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9108953428 | ||||||||
| FaxNumber: | 9108951410 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/09/2007 | ||||||||
| LastUpdateDate: | 03/31/2021 | ||||||||
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| AuthorizedOfficialLastName: | JONES | ||||||||
| AuthorizedOfficialFirstName: | CINDY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 7049861522 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| NPICertificationDate: | 03/31/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 320600000X | MHL-077-006 | NC | N | Residential Treatment Facilities | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 251S00000X | N | Agencies | Community/Behavioral Health | 311Z00000X | N | Nursing & Custodial Care Facilities | Custodial Care Facility | 320900000X | N | Residential Treatment Facilities | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 315P00000X | MHL-077-006 | NC | Y | Nursing & Custodial Care Facilities | Intermediate Care Facility, Mentally Retarded |
ID Information
| ID | Type | State | Issuer | Description | 3416332 | 05 | NC | MEDICAID |