MEDICARE: THE MENTAL HEALTH ASSOCIATION IN NORTH CAROLINA, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320800000X	Mental Illness Community Based Residential Treatment Facility	MHL-084-016	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316160302
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE MENTAL HEALTH ASSOCIATION IN NORTH CAROLINA, INC.

Provider Business Mailing Address
First Line	:	1331 SUNDAY DR
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27607-5166
Country	:	US
Telephone Number	:	919-866-3287
Fax Number	:

Provider Business Practice Location Address
First Line	:	2215 WAVERLY ST
Second Line	:
City	:	ALBEMARLE
State	:	NC
Zip	:	28001
Country	:	US
Telephone Number	:	704-983-2777
Fax Number	:

Authorized Official
Title or Position	:	FINANCIAL ASSISTANT
Name	:	MR. KEVIN COCHRAN
Credential	:
Telephone Number	:	919-866-3287

Provider Enumeration Date	:	04/10/2007
Last Update Date	:	08/22/2020

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