Healthcare Provider Details

I. General information

NPI: 1275971657
Provider Name (Legal Business Name): MONARCH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2013
Last Update Date: 06/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1080 NEAL RD
WALNUT COVE NC
27052-6991
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 336-591-5446
  • Fax: 336-591-3997
Mailing address:
  • Phone: 704-986-1522
  • Fax: 704-982-5279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

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