MEDICARE: SANDHILLS CENTER FOR MENTAL HEALTH, DEVELOPMENTAL DISABILITIES AND SUB

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

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	:	1912158643
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANDHILLS CENTER FOR MENTAL HEALTH, DEVELOPMENTAL DISABILITIES AND SUB

Provider Business Mailing Address
First Line	:	PO BOX 9
Second Line	:
City	:	WEST END
State	:	NC
Zip	:	27376-0009
Country	:	US
Telephone Number	:	910-673-9111
Fax Number	:	910-673-6202

Provider Business Practice Location Address
First Line	:	1116 SEVEN LAKES DRIVE
Second Line	:
City	:	WEST END
State	:	NC
Zip	:	27376-0009
Country	:	US
Telephone Number	:	910-673-9111
Fax Number	:	910-673-2015

Authorized Official
Title or Position	:	CFO
Name	:	TOMMY E. SCOTT
Credential	:
Telephone Number	:	910-673-9111

Provider Enumeration Date	:	09/30/2008
Last Update Date	:	09/30/2008

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