Healthcare Provider Details

I. General information

NPI: 1962543637
Provider Name (Legal Business Name): MONARCH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 03/31/2021
Certification Date: 03/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 E INGRAM ST
MOUNT GILEAD NC
27306-9246
US

IV. Provider business mailing address

350 PEE DEE AVE SUITE A
ALBEMARLE NC
28001-4945
US

V. Phone/Fax

Practice location:
  • Phone: 910-439-1307
  • Fax: 910-639-1565
Mailing address:
  • Phone: 704-986-1522
  • Fax: 704-982-5279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License NumberMHL-062-009
License Number StateNC

VIII. Authorized Official

Name: MRS. CINDY JONES
Title or Position: CFO
Credential:
Phone: 704-986-1522