Basic Information
| Provider Information | |||||||||
| NPI: | 1770956286 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SBH - RALEIGH, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | STRATEGIC BEHAVIORAL CENTER - GARNER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3200 WATERFIELD DR | ||||||||
| Address2: | |||||||||
| City: | GARNER | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275297727 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9198004400 | ||||||||
| FaxNumber: | 9195734163 | ||||||||
| Practice Location | |||||||||
| Address1: | 3200 WATERFIELD DR | ||||||||
| Address2: | |||||||||
| City: | GARNER | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275297727 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9198004400 | ||||||||
| FaxNumber: | 9195734163 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/05/2015 | ||||||||
| LastUpdateDate: | 11/05/2015 | ||||||||
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| AuthorizedOfficialLastName: | CAGLE | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 9019693100 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | STRATEGIC BEHAVIORAL HEALTH, LLC | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 283Q00000X | Y | Hospitals | Psychiatric Hospital |
No ID Information.