BEHAVIORAL HEALTH CENTER CMC RANDOLPH NPI 1104015023

NPI Information

NPI: 1104015023
Provider Name: BEHAVIORAL HEALTH CENTER CMC RANDOLPH

Other Name: COMMUNITY SUPPORT SERVICES

Classification: Clinic/Center - 261QM0850X
Entity Type: Organization

Specialization: Adult Mental Health

Address:
BEHAVIORAL HEALTH CENTER CMC RANDOLPH
501 BILLINGSLEY ROAD
CHARLOTTE, NC
ZIP 28211
Phone: (704) 444-2539
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BEHAVIORAL HEALTH CENTER CMC RANDOLPH is an adult mental health clinic center in Charlotte, NC. The provider is an entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in adults. BEHAVIORAL HEALTH CENTER CMC RANDOLPH NPI is 1104015023. The provider is registered as an organization entity type.
The provider Other Name Is Community Support Services.

The provider's business location address is:

BEHAVIORAL HEALTH CENTER CMC RANDOLPH
501 BILLINGSLEY ROAD
CHARLOTTE, NC
ZIP 28211-009
Phone: (704) 444-2539
Fax: (704) 444-2539

The provider's authorized official is Thomas E. Gettelman .
The authorized official title is Assistant Vice President and has the following contact phone number (704) 444-2406.

The enumeration date for this NPI number is 10/16/2007 and was last updated on 10/16/2007.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QM0850X	Clinic/Center	Adult Mental Health	H0071	NORTH CAROLINA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	8300443B	MEDICAID	NORTH CAROLINA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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