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General NPI Number Information
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NPI Number | 1659413698
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Entity Type | Organization
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Legal Business Name | UNIVERSAL MHDDSAS
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 10/15/2010
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Provider Practice Location Address
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Address Line | 10 N MAIN ST
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City | BURNSVILLE
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State | NC
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Zip | 28714-2925
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Country | US
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Telephone | 828-682-1551
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Fax |
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Provider Business Mailing Address
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Address Line | 839 WILKESBORO BLVD NE
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City | LENOIR
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State | NC
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Zip | 28645-4612
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Country | US
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Telephone | 828-759-2228
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Fax | 828-759-0159
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | BROOK PHILLIPS
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Credential |
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Telephone | 828-759-4064
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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