=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447790803
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MONARCH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/06/2017
-----------------------------------------------------
Last Update Date | 03/22/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1019 S MADISON ST
-----------------------------------------------------
City | WHITEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28472-4503
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-986-1500
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 350 PEE DEE AVE SUITE 101
-----------------------------------------------------
City | ALBEMARLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28001-4932
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EVP/CFO
-----------------------------------------------------
Name | MRS. CINDY B JONES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 704-986-1500
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------