| Granville Behavioral Health Services | |
|
102 Professional Park Ste A Oxford NC 27565-2554 | |
| (919) 690-3217 | |
| (919) 690-3218 |
| Full Name | Granville Behavioral Health Services |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 102 Professional Park Ste A, Oxford, North Carolina |
| Authorized Official Name and Position | Jamie Purvis (CFO) |
| Authorized Official Contact | 9196903237 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Granville Behavioral Health Services Po Box 947 Oxford NC 27565-0947 Ph: (919) 690-3000 | Granville Behavioral Health Services 102 Professional Park Ste A Oxford NC 27565-2554 Ph: (919) 690-3217 |
| NPI Number | 1710089164 |
|---|---|
| Provider Enumeration Date | 09/05/2006 |
| Last Update Date | 10/11/2024 |
| Certification Date | 10/11/2024 |
| Medicare PECOS PAC ID | 1052223757 |
|---|---|
| Medicare Enrollment ID | O20031103000034 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710089164 | NPI | - | NPPES |
| 6005338 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| 2084P0804X | Psychiatry & Neurology - Child & Adolescent Psychiatry | (* (Not Available)) | Secondary |
| Provider Name | Stephan Fredrick Baum |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1033289004 PECOS PAC ID: 6305825001 Enrollment ID: I20040716000099 |
| Provider Name | April E Welborn |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1497951404 PECOS PAC ID: 5092953257 Enrollment ID: I20130529000487 |
| Provider Name | Kerry Catherine Hopson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1417365685 PECOS PAC ID: 1759605637 Enrollment ID: I20150123002250 |
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