Healthcare Provider Details

I. General information

NPI: 1073639332
Provider Name (Legal Business Name): SOUTHMOUNTAIN CHILDREN & FAMILY SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 05/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7330 MYRTLE DR
NEBO NC
28761-8666
US

IV. Provider business mailing address

PO BOX 3387
MORGANTON NC
28680-3387
US

V. Phone/Fax

Practice location:
  • Phone: 828-584-1105
  • Fax: 828-584-8910
Mailing address:
  • Phone: 828-391-2803
  • Fax: 828-584-8910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License NumberMHL-012-079
License Number StateNC

VIII. Authorized Official

Name: MR. W. CHRIS JERNIGAN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 828-584-1105