=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992044143
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOLLY HILL HOSPITAL MOBILE CRISIS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/07/2013
-----------------------------------------------------
Last Update Date | 02/07/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 943 W ANDREWS AVE STE K
-----------------------------------------------------
City | HENDERSON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27536-2587
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-431-0280
-----------------------------------------------------
Fax | 252-431-0284
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 943 W ANDREWS AVE UNIT K
-----------------------------------------------------
City | HENDERSON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27536
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-431-0280
-----------------------------------------------------
Fax | 252-431-0284
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MOBILE CRISIS COUNSELOR
-----------------------------------------------------
Name | MRS. MARGO TIPPENS RAWLINGS
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 252-431-0280
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 283Q00000X
-----------------------------------------------------
Taxonomy Name | Psychiatric Hospital
-----------------------------------------------------
License Number | 283Q00000X
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------