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706 W King St Kings Mountain NC 28086-2708 | |
| (704) 739-3601 | |
| (980) 487-7416 |
| Full Name | |
|---|---|
| Speciality | Psychiatric Unit |
| Location | 706 W King St, Kings Mountain, North Carolina |
| Authorized Official Name and Position | Rose L Coyne (VP - CFO) |
| Authorized Official Contact | 9804873802 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 60548 Charlotte NC 28260-0548 Ph: (980) 487-7427 | 706 W King St Kings Mountain NC 28086-2708 Ph: (704) 739-3601 |
| NPI Number | 1609109933 |
|---|---|
| Provider Enumeration Date | 09/18/2009 |
| Last Update Date | 09/18/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609109933 | NPI | - | NPPES |
| 8000153 (CRNA) | Medicaid | NC | |
| 3400037 | Medicaid | NC | |
| 8907690 (PROFEE) | Medicaid | NC | |
| 235034G | Other | NC | MEDICARE OUTPATIENT PROFEE |
| 235034H | Other | NC | MEDICARE CRNA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 273R00000X | Psychiatric Unit | H0113 (North Carolina) | Primary |
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