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General NPI Number Information
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NPI Number | 1194877357
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Entity Type | Organization
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Legal Business Name | SIXTH AVENUE PSYCHIATRIC REHABILITATION PARTNERS
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 527 N JUSTICE ST
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City | HENDERSONVILLE
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State | NC
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Zip | 28739-4217
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Country | US
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Telephone | 828-697-9765
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Fax |
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Provider Business Mailing Address
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Address Line | 714 6TH AVE W
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City | HENDERSONVILLE
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State | NC
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Zip | 28739-4114
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OFFICE ADMINISTRATOR
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Name | MARY JO STARK
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Credential |
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Telephone | 828-697-1581
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 101236
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License Number State | NC
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