Basic Information
| Provider Information | |||||||||
| NPI: | 1902079098 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MOUNTAIN AREA RECOVERY CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3282 | ||||||||
| Address2: | |||||||||
| City: | ASHEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 288023282 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282528748 | ||||||||
| FaxNumber: | 8282529512 | ||||||||
| Practice Location | |||||||||
| Address1: | 414 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | CLYDE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287218026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8284540560 | ||||||||
| FaxNumber: | 8284568009 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2008 | ||||||||
| LastUpdateDate: | 04/09/2008 | ||||||||
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| AuthorizedOfficialLastName: | INGLE | ||||||||
| AuthorizedOfficialFirstName: | RHONDA | ||||||||
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| AuthorizedOfficialTitleorPosition: | BUSINESS MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8282528748 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | MHL044043 | NC | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
ID Information
| ID | Type | State | Issuer | Description | 5902776 | 05 | NC | MEDICAID |