Healthcare Provider Details

I. General information

NPI: 1003044165
Provider Name (Legal Business Name): MONARCH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2009
Last Update Date: 12/20/2020
Certification Date: 12/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 MIMOSA INN LN
TRYON NC
28782-8685
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 828-859-9770
  • Fax: 828-859-0261
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 TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier7805057
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer

VIII. Authorized Official

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