MEDICARE: ACADIA-VIDANT JOINT VENTURE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	283Q00000X	Psychiatric Hospital

General Provider Information

NPI Number	:	1770313470
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACADIA-VIDANT JOINT VENTURE, LLC

Provider Business Mailing Address
First Line	:	2820 MACGREGOR DOWNS RD
Second Line	:
City	:	GREENVILLE
State	:	NC
Zip	:	27834-8438
Country	:	US
Telephone Number	:	615-861-6000
Fax Number	:

Provider Business Practice Location Address
First Line	:	2820 MACGREGOR DOWNS RD
Second Line	:
City	:	GREENVILLE
State	:	NC
Zip	:	27834-8438
Country	:	US
Telephone Number	:	615-861-6000
Fax Number	:

Authorized Official
Title or Position	:	VP & SECRETARY
Name	:	BRIAN FARLEY
Credential	:
Telephone Number	:	615-861-6000

Provider Enumeration Date	:	08/06/2024
Last Update Date	:	08/06/2024

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