Healthcare Provider Details

I. General information

NPI: 1174788897
Provider Name (Legal Business Name): CAROLINAS MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2008
Last Update Date: 08/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 BILLINGSLEY ROAD CHS BEHAVIORAL HEALTH CHARLOTTE ADMINISTRATION
CHARLOTTE NC
28211-1009
US

IV. Provider business mailing address

501 BILLINGSLEY ROAD CHS BEHAVIORAL HEALTH CHARLOTTE ADMINISTRATION
CHARLOTTE NC
28211-1009
US

V. Phone/Fax

Practice location:
  • Phone: 704-358-2710
  • Fax: 704-358-2938
Mailing address:
  • Phone: 704-358-2710
  • Fax: 704-358-2938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier8300443
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer

VIII. Authorized Official

Name: MR. ANTHONY DEFURIO
Title or Position: EVP AND CHIEF FINANCIAL OFFICER
Credential:
Phone: 704-355-3304