Basic Information
| Provider Information | |||||||||
| NPI: | 1871828103 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | THE MENTAL HEALTH FUND INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CATAWBA VALLEY BEHAVIORAL HEALTHCARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3050 11TH AVENUE DR SE | ||||||||
| Address2: | |||||||||
| City: | HICKORY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286028336 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286955900 | ||||||||
| FaxNumber: | 8286954256 | ||||||||
| Practice Location | |||||||||
| Address1: | 2001 EASTSIDE DR | ||||||||
| Address2: | |||||||||
| City: | NEWTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286581933 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286955900 | ||||||||
| FaxNumber: | 8286954256 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2009 | ||||||||
| LastUpdateDate: | 09/13/2017 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | WATERS | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8286955900 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | LCSW | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 320800000X | N | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness | 320900000X | N | Residential Treatment Facilities | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.