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General NPI Number Information
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NPI Number | 1740417310
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Entity Type | Organization
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Legal Business Name | MISSIONHOSPITALS
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Dates
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Enumeration Date | 06/22/2009
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Last Update Date | 06/22/2009
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Provider Practice Location Address
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Address Line | 428 BILTMORE AVE
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City | ASHEVILLE
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State | NC
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Zip | 28801-4502
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Country | US
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Telephone | 828-213-4054
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Fax |
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Provider Business Mailing Address
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Address Line | 428 BILTMORE AVE
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City | ASHEVILLE
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State | NC
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Zip | 28801-4502
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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 | PSYCHIATRIC CLINICIAN
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Name | JEROLINE WILSON WOMMACK
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Credential | LCSW
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Telephone | 828-213-4054
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 283Q00000X
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Taxonomy Name | Psychiatric Hospital
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License Number | 002994
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License Number State | NC
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