Healthcare Provider Details

I. General information

NPI: 1548386220
Provider Name (Legal Business Name): BARIUM SPRINGS HOME FOR CHILDREN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 08/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1711 LANDIS HWY MOORESVILLE INTERMEDIATE DAY TX
MOORESVILLE NC
28115-6907
US

IV. Provider business mailing address

PO BOX 1
BARIUM SPRINGS NC
28010-0001
US

V. Phone/Fax

Practice location:
  • Phone: 704-873-1011
  • Fax: 704-832-2253
Mailing address:
  • Phone: 704-873-1011
  • Fax: 704-832-2253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberMHL049104
License Number StateNC

VIII. Authorized Official

Name: MR. JOHN KOPPELMEYER
Title or Position: PRESIDENT
Credential:
Phone: 704-872-4157