Healthcare Provider Details

I. General information

NPI: 1942608120
Provider Name (Legal Business Name): CIHA JUVENILE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2014
Last Update Date: 12/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 CHILDRENS HOME LOOP
CHEROKEE NC
28719
US

IV. Provider business mailing address

1 HOSPITAL RD CALLER BOX C-268
CHEROKEE NC
28719
US

V. Phone/Fax

Practice location:
  • Phone: 828-359-6690
  • Fax: 828-359-0014
Mailing address:
  • Phone: 828-497-9163
  • Fax: 828-497-1723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number StateNC

VIII. Authorized Official

Name: CASEY COOPER
Title or Position: CEO
Credential: CEO
Phone: 828-497-9163