Healthcare Provider Details

I. General information

NPI: 1235540212
Provider Name (Legal Business Name): ANDERSON BEHAVIORAL HEALTH, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2014
Last Update Date: 12/21/2020
Certification Date: 12/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1915 HASTY ROAD
MARSHVILLE NC
28103-8103
US

IV. Provider business mailing address

1915 HASTY RD
MARSHVILLE NC
28103-0029
US

V. Phone/Fax

Practice location:
  • Phone: 704-290-4246
  • Fax: 704-749-3842
Mailing address:
  • Phone: 704-624-4620
  • Fax: 704-624-0667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: DEMETRIC HAILEY
Title or Position: BILLING SPECIALIST
Credential:
Phone: 704-624-4620