Healthcare Provider Details

I. General information

NPI: 1306974068
Provider Name (Legal Business Name): CHERRY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 STEVENS MILL ROAD
GOLDSBORO NC
27530-1056
US

IV. Provider business mailing address

201 STEVENS MILL ROAD
GOLDSBORO NC
27530-1056
US

V. Phone/Fax

Practice location:
  • Phone: 919-731-3204
  • Fax: 919-731-3785
Mailing address:
  • Phone: 919-731-3204
  • Fax: 919-731-3785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number State

VIII. Authorized Official

Name: MR. J MICHAEL HENNIKE
Title or Position: SECTION CHIEF OF DMH DD SAS STATE O
Credential:
Phone: 919-855-4700