Basic Information
| Provider Information | |||||||||
| NPI: | 1477573897 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SANDHILLS CENTER FOR MENTAL HEALTH, DEVELOPMENTAL DISABILITIES AND SUB | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 9 | ||||||||
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| City: | WEST END | ||||||||
| State: | NC | ||||||||
| PostalCode: | 273760009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9106739111 | ||||||||
| FaxNumber: | 9106736202 | ||||||||
| Practice Location | |||||||||
| Address1: | 5841 US 421 SOUTH | ||||||||
| Address2: | |||||||||
| City: | BUIES CREEK | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9108935727 | ||||||||
| FaxNumber: | 9108936404 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2006 | ||||||||
| LastUpdateDate: | 03/04/2008 | ||||||||
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| AuthorizedOfficialLastName: | SCOTT | ||||||||
| AuthorizedOfficialFirstName: | TOMMY | ||||||||
| AuthorizedOfficialMiddleName: | E. | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 9106739111 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | N | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 261QM0801X | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
ID Information
| ID | Type | State | Issuer | Description | 5901794 | 05 | NC | MEDICAID |