Healthcare Provider Details

I. General information

NPI: 1982764825
Provider Name (Legal Business Name): DOROTHEA DIX HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 04/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 S BOYLAN AVE
RALEIGH NC
27603-2246
US

IV. Provider business mailing address

820 S BOYLAN AVE
RALEIGH NC
27603-2246
US

V. Phone/Fax

Practice location:
  • Phone: 919-733-5540
  • Fax: 919-733-0743
Mailing address:
  • Phone: 919-733-5540
  • Fax: 919-733-0743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. DALE ARMSTRONG
Title or Position: DIVISION DIRECTOR - DSOHF
Credential: MBA, FACHE
Phone: 919-855-4700