Healthcare Provider Details

I. General information

NPI: 1487900296
Provider Name (Legal Business Name): SBH-RALEIGH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2012
Last Update Date: 05/20/2021
Certification Date: 05/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 WATERFIELD DR
GARNER NC
27529
US

IV. Provider business mailing address

3200 WATERFIELD DR
GARNER NC
27529-7727
US

V. Phone/Fax

Practice location:
  • Phone: 919-573-4999
  • Fax:
Mailing address:
  • Phone: 919-573-4999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License NumberMHH 0973
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: JAMES CAGLE
Title or Position: CFO
Credential:
Phone: 901-969-3114