Healthcare Provider Details

I. General information

NPI: 1316745706
Provider Name (Legal Business Name): PRIMARY BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2025
Last Update Date: 03/03/2025
Certification Date: 03/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 PENNY RD
HIGH POINT NC
27260-2506
US

IV. Provider business mailing address

132 PENNY RD
HIGH POINT NC
27260-2506
US

V. Phone/Fax

Practice location:
  • Phone: 336-491-9983
  • Fax:
Mailing address:
  • Phone: 336-491-9983
  • Fax: 336-491-9983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number
License Number State

VIII. Authorized Official

Name: ANGEL COLEMAN
Title or Position: OWNER
Credential:
Phone: 336-491-9983