MEDICARE: BARIUM SPRINGS HOME FOR CHILDREN

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	322D00000X	Emotionally Disturbed Childrens' Residential Treatment Facility	MHL049086	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932226321
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BARIUM SPRINGS HOME FOR CHILDREN

Provider Business Mailing Address
First Line	:	PO BOX 1
Second Line	:
City	:	BARIUM SPRINGS
State	:	NC
Zip	:	28010-0001
Country	:	US
Telephone Number	:	704-873-1011
Fax Number	:	704-832-2253

Provider Business Practice Location Address
First Line	:	107 BARIUM SPRINGS DRIVE
Second Line	:	HOWARD HOME
City	:	STATESVILLE
State	:	NC
Zip	:	28677-6238
Country	:	US
Telephone Number	:	704-873-1011
Fax Number	:	704-832-2253

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JOHN KOPPELMEYER
Credential	:
Telephone Number	:	704-872-4157

Provider Enumeration Date	:	03/23/2007
Last Update Date	:	04/17/2008

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Practice Fax:

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