Basic Information
| Provider Information | |||||||||
| NPI: | 1720161987 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TRUE BEHAVIORAL HEALTHCARE INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2505 COURT DR | ||||||||
| Address2: | |||||||||
| City: | GASTONIA | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280542140 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7048426354 | ||||||||
| FaxNumber: | 7048426393 | ||||||||
| Practice Location | |||||||||
| Address1: | 2505 COURT DR | ||||||||
| Address2: | |||||||||
| City: | GASTONIA | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280542140 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7048426354 | ||||||||
| FaxNumber: | 7048426393 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2006 | ||||||||
| LastUpdateDate: | 02/22/2011 | ||||||||
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| AuthorizedOfficialLastName: | TRUESDELL | ||||||||
| AuthorizedOfficialFirstName: | CHANDA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7048426317 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251C00000X | N | Agencies | Day Training, Developmentally Disabled Services | 251S00000X | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 3410000 | 05 | NC | MEDICAID |