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706 W King St Kings Mountain NC 28086-2708 | |
| (704) 739-3601 | |
| (980) 487-7417 |
| Full Name | |
|---|---|
| Speciality | Psychiatric Unit |
| Location | 706 W King St, Kings Mountain, North Carolina |
| Authorized Official Name and Position | Rose L Coyne (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: (704) 739-3601 | 706 W King St Kings Mountain NC 28086-2708 Ph: (704) 739-3601 |
| NPI Number | 1790875953 |
|---|---|
| Provider Enumeration Date | 10/16/2006 |
| Last Update Date | 10/13/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790875953 | NPI | - | NPPES |
| 198264 | Other | NC | SC MEDICAID UB |
| 3400037S | Medicaid | NC | |
| 8907690 | Medicaid | NC | |
| NPA951 | Other | NC | SC MEDICAID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 273R00000X | Psychiatric Unit | H0113 (North Carolina) | Primary |
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